Mistaken Identity

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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. 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. 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. The condition is commonly misdiagnosed as plantar fasciitis. 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. 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. Return To The Case Studies List.		Back
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