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Mistaken Identity - Page #4
 

Working Diagnosis:
Baxter's Neuropathy

Treatment:
Anti-inflammatories started.

Outcome:
Patient was referred to physical therapy and nutrition for stretching/strengthening exercises and weight loss, respectively. <br> <br>Symptoms did not respond to conservative therapy, and patient was thus referred to Orthopedic Surgery for possible surgical intervention.

Author's Comments:
Baxter's Neuropathy is a condition where the inferior calcaneal nerve, or "Baxter's nerve," is compressed. <br> <br>The nerve supplies sensory innervation to the plantar surface of the foot and provides motor inputs to a few muscles of the foot, including abductor digiti minimi and the flexor digitorum. The functions of these muscles will be affected, likely resulting in weakness in affected foot. <br> <br>The condition is commonly misdiagnosed as plantar fasciitis. <br> <br>The imaging study of choice is an MRI which will often show inflammation or atrophy of the abductor digiti minimi muscle. Treatment involves anti-inflammatories, correcting underlying pathology, and potential surgical intervention.

Editor's Comments:
Heel pain can be difficult to treat, especially in refractory cases. Baxter's neuropathy is a more common diagnosis than previously thought and should be considered. As musculoskeletal ultrasound continues to gain popularity, another new treatment option that has been explored for this conditions is ultrasound-guided hydrodissection of the nerve. This treatment option has shown long-lasting relief in previous case reports and is another option for patients prior pursuing surgery.

References:
1. Sahoo RK, Peng PW, and Sharma SK. Ultrasound-Guided Hydrodissection for Baxter's Neuropathy Secondary to Plantar Fasciitis: A Case Report. A A Pract. 2020 Nov;14(13):e01339. doi: 10.1213/XAA.0000000000001339. <br>2. Jaring MR, Khan AZ, Livingstone JA, and Chakraverty J. A Case of Bilateral Baxter's Neuropathy Secondary to Plantar Fasciitis. J Foot Ankle Surg. 2019 Jul;58(4):771-774. doi: 10.1053/j.jfas.2018.11.010. Epub 2019 Apr 24.

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