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Baxter's Neuritis (Calcaneal Nerve Neuritis)

Discussion in 'General Issues and Discussion Forum' started by Jaimee Brent, Sep 25, 2009.

  1. Jaimee Brent

    Jaimee Brent Active Member


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    Hi,

    I've been looking into the phenomenon of baxter's neuritis and have found the evidence base quite wanting.

    We havent really been told much about this disorder within uni, although i have found significant exposure within clinics, especially in associtation with Plantar Fasciitis.

    i was curious if this is a well recognised disorder/cause of heel pain? and if it is well known within the podiatric community?

    furthermore it would be interesting to hear how ppl like to treat it? as i have heard of LA, dry needling, prolotherapy, acupuncture, orthoses and much more being used clinically...however i havent really been able to uncover any studies (specific) on the area.

    Is this an area of podiatry that is yet to have an evidence base developed???

    Any thoughts would be greatly appreciated.

    Thankyou,
    Jaimee
     
  2. Admin2

    Admin2 Administrator Staff Member

  3. drsarbes

    drsarbes Well-Known Member

    Hi Jaimee:
    Ill give you my thoughts on this entity:

    I see quite a high percentage of patients with plantar fasciitis also demonstrating neuritic pain (my guess is around 15%)

    Some of these are classic Tarsal Tunnel syndromes with pain radiating into the heel, arch, forefoot, toes, all or some; with a positive Tinel's sign at the Tarsal Tunnel proper and pain on palpation of the post tib nerve.

    Some of these are pain radiating (or just "penetrating type pain) into the arch, forefoot with a Positive Tinel's sign NOT at the Tarsal Tunnel but at the opening of the Porta Pedis at the proximal border of the AHB muscle belly. Pain on palpation of the porta pedis.

    Other have a questionable Tinel's sign (paresthesia's on percussion without classic radiation) at the distal end of the Tarsal Tunnel along the medial to medial posterior aspect of the Os Calcis (i.e., the area of the Medial Calcaneal Branch) pain on palpation of the medial aspect of the os calcis posterior to the neurovascular bundle.

    My own feeling, having actually explored surgically literally hundreds of tarsal tunnel syndrome patients, is that sometimes the medial Calcaneal branch is more involved in TT Syndrome than in others, the Med Cal Br. can be sen to be hypertrophied or at least thicker than one would normally see it. Also, many times I will see individual horizontal bands of fascial deep to the laciniate ligament traverse this nerve branch which, in my opinion, causes nerve irritation.

    Weather these are Dx as Tarsal Tunnel or perhaps SUBcategorized at Medial Calcaneal Nerve neuritis is the question. In my own practice, I just have not seen many patients with localized pain attributed to a select irritation of only the Med. Calcaneal branch.

    I know neurosurgical technique for releasing a Tarsal Tunnel includes resection of the Medial Calcaneal branch after ligament release.

    hope this helps

    Steve
     
  4. Jaimee Brent

    Jaimee Brent Active Member

    Thanks, That is really rather interesting. In your experience have you ever found that patients can gain sucessful relief with conservative tx? if so what forms do you advise?

    Jaimee
     
  5. drsarbes

    drsarbes Well-Known Member

    Hi Jaimee:

    If you have a patient you suspect of med calcaneal nerve pain I would first try to come up with an underlying etiology; i.e., repetitive stress, pathomechanical, trauma, etc.....and go from there, treating accordingly.

    I've had fairly good luck (sometimes short term) with Lidoderm patches.

    Good luck

    Steve
     
  6. Lawrence Bevan

    Lawrence Bevan Active Member

    i think the "Baxter's nerve" and medial plantar nerve neuritis are different entities.

    The "Baxters nerve" is an alledged entrapment of a branch of the lateral plantar nerve that innervates abductor digiti minimi. It supposedly becomes entraped between the calcaneus and the plantar fascia. The symptoms mimic PF. I dont know if anyone else has ever reported on it.

    Plantar medial calcaneal nerve entrapment is as Steve described it - neuralgic symptoms, not necessarily any of the 1st step pain associated with PF and often a history of previously failed orthotics. They probably would have an ultrasound negative for changes in the PF but thats my conjecture. I find a targeted injection of Depomedrone plus orthotic with an aperture in the medial heel cup (shank dependent materials) works ok.
     
  7. drsarbes

    drsarbes Well-Known Member

    Lawrence:
    You are absolutely correct.
    I saw "medial calcaneal nerve" and took off from there.
    Sorry if I confused anyone, guess I just answered the wrong question!

    Steve
     
  8. Jaimee Brent

    Jaimee Brent Active Member

    Thankyou both.
    I have been under the impression that "baxter's nerve" was another title/name for the Medial Calcaneal Nerve.
    Thanks for clearing that up!

    and you answered my question fantastically! it seems i just asked it wrong :D

    Jaimee
     
  9. Baxter's neuritis, or entrapment of the first branch of the lateral plantar nerve is a real diagnosis. I don't see it that often, but I have operated on a few of these cases and the surgery has routinely produced excellent relief of the heel pain. One of the signs that generally occurs is a lack of the ability of the patient to abduct their 5th digit forcefully away from 4th digit due to the nerve affected being the motor branch to the abductor digiti quinti muscle. Also the patient's tenderness is more medial over the abductor hallucis muscle belly, not on the medial calcaneal tubercle as is most commonly seen in proximal plantar fasciitis. Even these are not that common, it is still one of the differentials of heel pain that we must always keep in mind as podiatrists. In my hands, custom foot orthoses and injections help less than 50% of these patients whereas surgical release has given complete relief in the few patients I have done this surgery on.

    Hope this helps.
     
  10. Jaimee Brent

    Jaimee Brent Active Member

    That has helped a lot thankyou!

    i was curiious what type of surgical procedure do you generally perform on Baxters neuritis patients???

    and what type of treatment conservative vs surgical would you apply to someone with Medial Calcaneal Nerve Neuritis?

    Do any of you use LA injections/dry needling or acupuncture? as i have seen there use in some clinics but have been able to find v few articles on LA and none on acupuncture for this kind of problem???

    Thankyou,
    Jaimee
     
  11. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    Bilateral Baxter's neuropathy secondary to plantar fasciitis.
    Dirim B, Resnick D, Ozenler NK.
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  13. Matt01

    Matt01 Member

    A timely post, NewsBot. Just sent a pt of for a scan of the FBLPN today, will be interesting to see if my local sonographer can pick it up.
     
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