Massage & Bodywork

MARCH | APRIL 2016

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In Baxter's neuropathy, there are two potential locations of entrapment of the ICN. The first is between the deep fascia of the abductor hallucis muscle and the quadratus plantae muscle (Image 3). The second is along the medial calcaneal tuberosity, where the nerve can be compressed against the bone or bone spurs that may have developed along the anterior calcaneus (Image 4). Bone spurs at the anterior calcaneus are assumed to result from tensile forces on the attachment sites of the toe flexor muscles or the plantar fascia. The presence of bone spurs is frequently described as a primary cause for heel or foot pain. However, recent theories have suggested that while bone spurs may be a result of certain biomechanical forces in the foot, they may not be a primary cause of foot pain. Because bone spurs occur on the anterior calcaneus, it is unlikely there is pressure from weight bearing directly on the spur. Additionally, bone spurs also occur in other locations in the body without being painful. It may be that in a case where bone spurs are present, ICN nerve compression is a primary cause of the pain. The spur can project into the path of the ICN and cause increased nerve compression. ASSESSMENT Baxter's neuropathy may account for up to 20 percent of heel pain cases. 2 A description of this condition does not occur frequently in orthopedic literature, which suggests that if it is thought to be present in 20 percent of heel pain cases, it may be being misdiagnosed. If it is misdiagnosed as another common condition such as plantar fasciitis, traditional treatments could be ineffective or actually make the condition worse. Treatment approaches for plantar fasciitis are highly variable, so it's wise to consider the possibility that ICN compression is a factor in any long-term complaint, especially if the pain does not respond to traditional treatment. The ICN is a mixed motor and sensory nerve, so nerve compression may cause pain in the foot or ankle, along with muscular atrophy if the motor fibers are affected. When motor fibers are involved, the abductor digiti minimi (ADM) muscle is the one most commonly affected, although the ICN also may innervate C h e c k o u t A B M P 's l a t e s t n e w s a n d b l o g p o s t s . Av a i l a b l e a t w w w. a b m p . c o m . 99 3 A small passage between the quadratus plantae and abductor hallucis muscles can trap the inferior calcaneal nerve. Image courtesy 3D4Medical's Essential Anatomy 5 application. Abductor hallucis Quadratus plantae 5 The flexor digitorum brevis and quadratus plantae can be potentially innervated by the ICN branch. Image courtesy 3D4Medical's Essential Anatomy 5 application. Flexor digitorum brevis Quadratus plantae 4 The inferior calcaneal nerve can be entrapped along the medial calcaneal tuberosity. Image courtesy 3D4Medical's Essential Anatomy 5 application. Abductor digiti minimi Medial calcaneal tuberosity

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