Baxter's Nerve Entrapment: Difference between revisions

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== Anatomy ==
== Anatomy ==
[[File:Baxter nerve.jpg|thumb|233x233px|Baxter nerve (Nerve to abductor digiti quinti).<ref name=":0">{{Cite journal|last=Baxter|first=D. E.|last2=Thigpen|first2=C. M.|date=1984-07|title=Heel pain--operative results|url=https://pubmed.ncbi.nlm.nih.gov/6479759|journal=Foot & Ankle|volume=5|issue=1|pages=16ā€“25|doi=10.1177/107110078400500103|issn=0198-0211|pmid=6479759}}</ref>]]
[[File:Baxter nerve.jpg|thumb|290x290px|Baxter nerve (Nerve to abductor digiti quinti).<ref name=":0">{{Cite journal|last=Baxter|first=D. E.|last2=Thigpen|first2=C. M.|date=1984-07|title=Heel pain--operative results|url=https://pubmed.ncbi.nlm.nih.gov/6479759|journal=Foot & Ankle|volume=5|issue=1|pages=16ā€“25|doi=10.1177/107110078400500103|issn=0198-0211|pmid=6479759}}</ref>]]
The [[Inferior Calcaneal Nerve (Baxter Nerve)|inferior calcaneal nerve (Baxter nerve)]] is the first branch of the [[Lateral Plantar Nerve|lateral plantar nerve]], which is itself a branch of the [[Tibial Nerve|tibial nerve]]. The nerve lies in between the abductor hallucis muscle and quadratus plantae.
The [[Inferior Calcaneal Nerve (Baxter Nerve)|inferior calcaneal nerve (Baxter nerve)]] is the first branch of the [[Lateral Plantar Nerve|lateral plantar nerve]], which is itself a branch of the [[Tibial Nerve|tibial nerve]]. The nerve lies in between the abductor hallucis muscle and quadratus plantae.


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== Aetiology ==
== Aetiology ==
There are three entrapment points:<ref name=":1">Bauones, S., Feger, J. Baxter neuropathy. Reference article, Radiopaedia.org. (accessed on 15 Apr 2022) <nowiki>https://doi.org/10.53347/rID-25994</nowiki></ref>
There are three entrapment points:<ref>{{Cite web|date=2012-08-01|title=Baxter's Nerve (First Branch of the Lateral Plantar Nerve) Impingement|url=https://radsource.us/baxters-nerve/|access-date=2022-04-16|website=Radsource|language=en-US}}</ref>


# Deep to or adjacent to the fascial edge of a hypertrophied [[Abductor Hallucis]] muscle
# Between the deep fascia of the [[Abductor Hallucis]] and medial plantar margin of the [[Quadratus Plantae]]
# Along the medial edge of the [[Quadratus Plantae]]
# More distally along the anterior aspect of the medial calcaneal tuberosity. A calcaneal plantar enthesophyte and/or soft tissue changes of plantar fasciitis may contribute to entrapment at this second location.
# Adjacent to the medial calcaneal tuberosity.
Ā 
[[Tarsal Tunnel Syndrome|Tarsal tunnel syndrome]] is a related condition but involves entrapment more proximally in the tarsal tunnel.


== Risk Factors ==
== Risk Factors ==
[[Obesity and Chronic Pain|Obesity]], diabetes, muscle hypertrophy, hyperpronated foot, pes planus, plantar calcaneal spur, [[Plantar Fasciitis|plantar fasciitis]], [[spondyloarthritis]]. Ā 
[[Obesity and Chronic Pain|Obesity]], age, diabetes, muscle hypertrophy, hyperpronated foot, pes planus, plantar calcaneal spur, [[Plantar Fasciitis|plantar fasciitis]], [[spondyloarthritis]]. Ā 


== Clinical Features ==
== Clinical Features ==
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== Investigations ==
== Investigations ==
[[File:Baxter nerve entrapment MRI.jpeg|thumb|Coronal PD image showing fatty atrophy.<ref name=":1" />]]
[[File:Baxter nerve entrapment MRI.jpeg|thumb|Coronal PD image showing fatty atrophy.<ref name=":1">Bauones, S., Feger, J. Baxter neuropathy. Reference article, Radiopaedia.org. (accessed on 15 Apr 2022) <nowiki>https://doi.org/10.53347/rID-25994</nowiki></ref>]]
On MRI in the acute phase there is decreased T1 signal intensity and increased T2 signal intensity with fat saturation in the muscles innervated by the Baxter nerve. In the chronic phase there is fatty change of the [[Abductor Digiti Minimi|abductor digiti minimi]] muscle, and occasionally the [[Flexor Digitorum Brevis]] and [[Quadratus Plantae]].
On MRI in the acute phase there is decreased T1 signal intensity and increased T2 signal intensity with fat saturation in the muscles innervated by the Baxter nerve. In the chronic phase there is fatty change of the [[Abductor Digiti Minimi|abductor digiti minimi]] muscle, and occasionally the [[Flexor Digitorum Brevis]] and [[Quadratus Plantae]].


==Treatment==
==Treatment==
[[File:Baxter nerve injection.mp4|thumb|Baxter nerve injection.<ref>Baxter's nerve Sd. Procedure: corticosteroid injection & orthotics. Good result. @Dr_Ramon_Balius #MSKUltrasound pic.twitter.com/ED9RcmqJnz</ref>]]
The nerve can be injected with corticosteroid and/or hydrodissected under ultrasound guidance.
Ā 
== External Links ==
[https://radsource.us/baxters-nerve/ Baxter's Nerve (First Branch of the Lateral Plantar Nerve) Impingement - Radsource][[File:Baxter nerve injection.mp4|thumb|Baxter nerve injection.<ref>Baxter's nerve Sd. Procedure: corticosteroid injection & orthotics. Good result. @Dr_Ramon_Balius #MSKUltrasound pic.twitter.com/ED9RcmqJnz</ref>]]


==References==
==References==

Revision as of 10:26, 16 April 2022

Baxter's nerve entrapment, also known as Baxter neuropathy, is plantar heel pain arising from compression of the inferior calcaneal nerve (Baxter nerve).

Anatomy

Baxter nerve (Nerve to abductor digiti quinti).[1]

The inferior calcaneal nerve (Baxter nerve) is the first branch of the lateral plantar nerve, which is itself a branch of the tibial nerve. The nerve lies in between the abductor hallucis muscle and quadratus plantae.

The Gray's anatomy image and many other anatomy textbook images are incorrect. The Baxter nerve is quite posterior and lies very close to the calcaneus. It was named after Donald Baxter.[1]

Aetiology

There are three entrapment points:[2]

  1. Between the deep fascia of the Abductor Hallucis and medial plantar margin of the Quadratus Plantae
  2. More distally along the anterior aspect of the medial calcaneal tuberosity. A calcaneal plantar enthesophyte and/or soft tissue changes of plantar fasciitis may contribute to entrapment at this second location.

Risk Factors

Obesity, age, diabetes, muscle hypertrophy, hyperpronated foot, pes planus, plantar calcaneal spur, plantar fasciitis, spondyloarthritis.

Clinical Features

The clinical features may be similar to or coexist with plantar fasciitis. However there may be less morning pain, occasional altered sensation, and intrinsic muscle atrophy.

Differential Diagnosis

Differential Diagnosis of Heel Pain

Investigations

Coronal PD image showing fatty atrophy.[3]

On MRI in the acute phase there is decreased T1 signal intensity and increased T2 signal intensity with fat saturation in the muscles innervated by the Baxter nerve. In the chronic phase there is fatty change of the abductor digiti minimi muscle, and occasionally the Flexor Digitorum Brevis and Quadratus Plantae.

Treatment

The nerve can be injected with corticosteroid and/or hydrodissected under ultrasound guidance.

External Links

Baxter's Nerve (First Branch of the Lateral Plantar Nerve) Impingement - Radsource

Baxter nerve injection.[4]

References

  1. ā†‘ 1.0 1.1 Baxter, D. E.; Thigpen, C. M. (1984-07). "Heel pain--operative results". Foot & Ankle. 5 (1): 16ā€“25. doi:10.1177/107110078400500103. ISSN 0198-0211. PMID 6479759. Check date values in: |date= (help)
  2. ā†‘ "Baxter's Nerve (First Branch of the Lateral Plantar Nerve) Impingement". Radsource (in English). 2012-08-01. Retrieved 2022-04-16.
  3. ā†‘ Bauones, S., Feger, J. Baxter neuropathy. Reference article, Radiopaedia.org. (accessed on 15 Apr 2022) https://doi.org/10.53347/rID-25994
  4. ā†‘ Baxter's nerve Sd. Procedure: corticosteroid injection & orthotics. Good result. @Dr_Ramon_Balius #MSKUltrasound pic.twitter.com/ED9RcmqJnz
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