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98 m a s s a g e & b o d y w o r k m a r c h / a p r i l 2 0 1 6 technique SCIENCE OF NERVES Baxter's Neuropathy Solutions for Plantar Foot Pain By Whitney Lowe Pain on the bottom surface of the foot can be a debilitating condition; in some cases, it persists for several years. The most common cause of plantar foot pain is plantar fasciitis, and pain on the underside of the foot that is aggravated with activity is often diagnosed as such. Yet, in some cases, this pain does not respond to typical therapies for plantar fasciitis and persists unchecked. When standard treatments are unsuccessful, the primary problem may not be with the plantar fascia at all. A potential cause of plantar foot pain that can easily mimic symptoms of plantar fasciitis is compression of the inferior calcaneal nerve (ICN) under the arch of the foot. The ICN is a branch of the lateral plantar nerve on the bottom surface of the foot. The nerve is also sometimes called Baxter's nerve, named after the first physician to describe this nerve compression as a specific cause of foot pain. Compression pathology of this nerve is therefore called Baxter's neuropathy. LOCATION AND STRUCTURE The tibial nerve divides into two primary branches—the medial and lateral plantar nerves—as it passes around the medial side of the ankle in the tarsal tunnel (Image 1). Both branches then curve around the medial ankle and course along the bottom surface of the foot. The first smaller branch that splits off from the lateral plantar nerve is the ICN (Image 2). In most people, the ICN branch splits off from the lateral plantar nerve on the underside of the foot. However, in some cases, the ICN may actually branch off more proximally—even as far up as the tarsal tunnel on the medial ankle. Where and how a nerve branches is clinically relevant because nerve branching can increase tensile or compressive loads on the nerve and lead to nerve injury. 1 Another factor that makes the plantar nerves and their branches more susceptible to injury and irritation is the sharp right-angle turn they take from the medial side of the foot to the plantar surface. 1 2 The split of the medial and lateral plantar nerves in the right ankle. Image courtesy 3D4Medical's Essential Anatomy 5 application. The inferior calcaneal nerve branches from the lateral plantar nerve. Image courtesy 3D4Medical's Essential Anatomy 5 application. Medial plantar nerve Lateral plantar nerve Inferior calcaneal nerve branch