Baxter's nerve entrapment is an under-recognised cause of chronic heel pain and is frequently mistaken for plantar fasciitis because the symptoms can overlap. In some patients, both conditions occur together, making diagnosis even more challenging. Establishing the correct diagnosis is important because treatment directed only at the plantar fascia may not relieve pain if the nerve is also irritated.
The diagnosis begins with a detailed history. Patients often describe pain on the inside of the heel that may radiate towards the arch. Some report burning, tingling or aching discomfort, while others simply notice persistent heel pain that has failed to respond to otherwise appropriate treatment. Pain may worsen after prolonged standing or walking and can continue even after activity has stopped.
A careful physical examination is essential. The location of tenderness, reproduction of symptoms with palpation, assessment of muscle strength, foot posture, gait and range of motion all provide valuable diagnostic clues. The examination also helps exclude other common causes of heel pain, including plantar fasciosis, heel fat pad syndrome, stress injury and inflammatory conditions.
Diagnostic ultrasound is a valuable adjunct because it allows the plantar fascia and surrounding soft tissues to be examined in real time. Although the nerve itself may not always be visualised clearly, ultrasound can identify associated plantar fascia degeneration, guide examination of the painful region and assist with image-guided procedures. MRI may be recommended when deeper pathology, muscle changes or alternative diagnoses are suspected.
In selected patients, a carefully placed ultrasound-guided local anaesthetic injection around Baxter's nerve may assist the diagnostic process. If pain is significantly reduced immediately after the injection, this supports the diagnosis that the nerve is contributing to the symptoms. Diagnostic injections should always be interpreted alongside the patient's history, examination and imaging findings rather than in isolation.
The most important lesson is that Baxter's nerve entrapment should always be considered in patients whose heel pain has persisted despite treatment for plantar fasciitis. Recognising the condition early helps ensure treatment targets the true source of pain rather than repeatedly treating the wrong structure.