Heel pain, or talalgia, may be due to entrapment or compression of the first branch of the lateral plantar nerve of the foot, also known as the Baxter nerve. Compression of this nerve is an underdiagnosed cause of talalgia because it presents symptoms similar to other pathologies, especially plantar fasciitis.
The posterior tibial nerve on its way through the tarsal tunnel branches to innervate the medial region of the calcaneus. Nerve entrapment occurs when the plantar and abductor hallucis muscle compress the nerve. This neuropathy can be the cause of up to 20% of heel discomfort, especially in people who perform sports activities that require the use of the abductor musculature of the first toe.
There are several causes that produce talalgia or pain in the heel region. The most common is plantar fasciitis. However, it is important to rule out other causes such as fibrillar ruptures, calcaneal stress fractures, other neuropathies and bone tumors.
Heel diagnosis
To make a correct diagnosis, a complete examination should be performed and the clinical picture of heel pain should be assessed.
The pain produced by the compression of Baxter’s nerve differs from plantar fasciitis in its intensity, since it is not felt as acutely in the first steps of the morning as it is felt by people suffering from plantar fasciitis.
The diagnosis should be made with magnetic resonance imaging to detect denervation related to muscle changes that confirm the diagnosis of Baxter’s nerve entrapment.
Conservative treatment to relieve the compression of Baxter’s nerve may initially include orthopedic insoles, anti-inflammatories, infiltrations and rest. In cases where pain persists, surgery has been shown to be very effective in the complete resolution of this neuralgia. The surgery consists of performing a neurolysis of Baxter’s nerve together with a decompression of the tarsal tunnel. Minimally invasive surgery, laparoscopic and radiofrequency ablation are the most indicated techniques and have a fast and comfortable postoperative period.
Article prepared by Clínica San Román
Date of publication: 30-05-2018
Revision date: 31-01-2020
