Conditions & Treatments - Baxter's Nerve Extrapment ׀ by  Bill Lyon, PT, DPT, OCS, CSCS, USAW-L1


Bill Lyon, PT, DPT, OCS, CSCS, USAW-L1 received his doctor of physical therapy degree from the University of Wisconsin - Milwaukee. He has more than 11 years of experience in performance training and strength & conditioning and is a Certified Strength and Conditioning Specialist through the NSCA as well as a Level one Olympic lifting coach through United States Weightlifting. Bill is a physical therapist with United Hospital System in Kenosha where he works primarily in an outpatient physical therapy setting.


Baxter's Nerve Entrapment


Plantar fasciitis is possibly the most common foot and ankle referral diagnosis seen in the orthopedic physical therapy clinic. Patients typically report pain in the bottom or sides of the heel that can be quite debilitating and greatly impact daily life. While most heel referrals are likely to be labeled at plantar fasciitis, it’s important to also consider another fairly common condition that may be present, inferior calcaneal nerve (Baxter’s nerve) entrapment.

The inferior calcaneal nerve is also commonly referred to as Baxter’s nerve. Named after the physician, Dr. Donald Baxter, who first described the condition in 1984, it is the first branch of the lateral plantar nerve. Baxter’s nerve is a mixed motor and sensory nerve and supplies motor innervation to the abductor digiti minimi muscle. There are three areas where the nerve can become entrapped: deep to or adjacent to the edge of a hypertrophied abductor halluces, along the medial edge of the quadratus plantae, and adjacent to the medial calcaneal tuberosity. A calcaneal enthesophyte and/or soft tissue changes seen in progression of plantar fasciitis can contribute to entrapment at the last location.

Baxter’s nerve entrapment has been claimed to account for up to 20% of heel pain cases. While it is common in the general population, it has also been shown to be common with the athletic population as well. According to one study, up to 50% of cases are due to athletic activity, with it accounting for 15% of persistent heel pain in athletes, especially long distance runners due to hypertrophy of abductor halluces in that population. Patients with Baxter’s nerve entrapment will commonly come in with many of the same complaints as those with a true plantar fasciitis. In fact, the evidence shows that often the two conditions may happen at the same time, and the nerve entrapment may increase with soft tissue changes of the plantar fascia, at least earlier on in the condition.

So how do we tell the difference? There are no clinical tests to successfully rule in or out the presence of Baxter’s nerve impingement at this time, so differential diagnosis involves paying close attention to pain details during subjective questioning, as well as possible failure of conservative treatment of the plantar fascia. In typical plantar fasciitis, the patient will complain of significant pain when taking the first few steps following sleeping or after prolonged sitting, referred to as post-static dyskinesia, as well as reduction in pain when not weight bearing. In contrast, Baxter’s nerve impingement will tend to demonstrate increasing pain as the day goes on and continued weight bearing. Patients will also tend to demonstrate pain even when they are not weight bearing with nerve entrapment. In some cases, but not all, there are slight paresthesias present on the lateral foot. The patient may also lose the ability to abduct the fifth digit if motor function is compromised, but that is something for many people in the general population to do, so its usefulness in diagnosis may be limited. Injections of lidocaine can also be used by the physician for diagnosis, looking for relief of symptoms with small amounts injected at the location of the nerve.

Treatment tends to be conservative in nature and includes NSAIDS, rest, orthotics, and corticosteroid injections. If pain persists there are surgical options, most commonly neurolysis, with or without release of any tight fascial restrictions. Therapy is often also used to alleviate any of the ROM and strength limitations that may have led to the initial insult.


Last revised: 8/18/16
by Bill Lyon, PT, DPT, OCS, CSCS, USAW-L1


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