Baxters neuropathy (Runners foot)

The Baxter’s nerve, also known the first branch of the lateral plantar nerve, is a small nerve (under 1mm in diameter) running along the inside of the heel.  It is an uncommon cause of heel pain, but one that should be considered when pain is not improving, particularly if you have been diagnosed with plantarfasciitis. This tiny nerve is responsible for providing muscular control to three small muscles of the foot, quadratus plantae, abductor digiti minimi and the flexor digitorum brevis.  It also provides sensation to the heel bone (calcaneus) (Presley et al., 2013).

The Baxter’s nerve is a branch of a larger nerve, called the tibial nerve.  The tibial nerve provides the calf muscles with both muscle control and sensation.

What is a neuropathy?

A neuropathy is an irritation of a nerve.  Neuropathies can occur all over the body and often present as;

• Weakness

• Numbness

• Tingling (pins and needles)

• Burning pain

• Shooting pain

• Loss of balance

Neuropathy can be a result of a variety of different causes such as;

• Trauma – for example following an ankle sprain

• Nerve entrapment – the nerve can become pinched by other surrounding structures such as tight muscles

• Infection

• Diabetes

• Viruses such as shingles

• Some medications can also cause neuropathy

What are the symptoms of a Baxter’s nerve neuropathy?

Symptoms of a Baxter’s neuropathy include;

• Sharp or burning pain that runs along the inner aspect of the heel bone (calcaneus) and into the arch of the foot

• Tenderness of the nerve on the inside of the heel

• Pins and needles when the nerve is tapped. ‘Tapping’ the nerve to reproduce the symptoms is called Tinel’s Sign. This will be carried out by your physiotherapist.

The symptoms can be very similar to those experienced with plantarfasciitis (the most common cause of heel pain).

What causes Baxter’s neuropathy?

A Baxter’s neuropathy is predominantly a nerve entrapment issue.  It occurs when the Baxter’s nerve becomes pinched or trapped as it passes under the heel (see below) through two muscles of the inner foot, the quadratus plantae and the abductor hallucis.