Symptoms and causes
Baxter’s neuropathy
A trapped nerve in the heel that looks so much like plantar fasciitis that it is usually treated as plantar fasciitis — which is the main reason some heel pain never gets better.
Written by the Managing Neuropathy editorial team under the direction of Dr. Tom Biernacki, DPM, FACFAS · Clinical review pending · Last updated 7 September 2026
The short answer. Baxter’s nerve is the first branch of the lateral plantar nerve. It turns a sharp corner deep inside the inner heel and can be compressed there, producing pain in almost the same place as plantar fasciitis. It is a recognized cause of a meaningful minority of chronic heel pain. The features that separate it: burning rather than tearing, pain that persists at rest and sometimes at night, tenderness slightly deeper and more toward the inner side than the classic fascia spot, and heel pain that has not responded to good plantar fasciitis treatment.
Which nerve, and where it gets caught
The tibial nerve comes down behind the inner ankle and divides in the sole. The first branch to leave the lateral plantar division is the one described by Baxter, and it takes an awkward route: it turns from running downward to running across the foot, passing between the deep fascia of the abductor hallucis muscle and the muscle beneath it, then travelling under the heel bone to reach the small muscle on the outer side of the foot.
Two things about that route matter. It changes direction sharply in a tight fascial gap, which is exactly the geometry that makes nerves vulnerable. And it carries both sensation and a motor supply, so a long-standing compression can leave a signature on imaging in the form of changes in the muscle it supplies — which is one of the few objective findings available.
Why it gets called plantar fasciitis
Because it hurts in roughly the same place, in the same people, doing the same activities. Both are more common in runners, in people who stand all day, in people who have gained weight, and in feet that roll inward. Both hurt underneath the inner heel. And the two frequently coexist — thickened fascia and inflamed tissue crowd the space the nerve runs through, so a fasciitis can produce a nerve compression, which is why treating one and not the other leaves a stubborn residue.
What tends to separate them
| Feature | Plantar fasciitis | Baxter’s neuropathy |
|---|---|---|
| Quality | Sharp, tearing, focal | Burning, tingling, aching, sometimes radiating across toward the outer heel |
| First steps in the morning | Classically the worst moment | Often present, but less dominant; some people are worst later in the day |
| At rest | Usually settles with rest | Can persist sitting or lying, and can be present at night |
| Most tender point | The fascia insertion at the front of the heel bone | Slightly deeper and more toward the inner border of the heel, over the abductor muscle |
| Response to good treatment | Most improve with stretching, orthoses and load management | Improves less, or plateaus |
None of these is decisive on its own. The pattern that should raise the question is heel pain that has had six months of competent plantar fasciitis treatment and has not moved, particularly if the description is burning rather than sharp.
How it is assessed
- Examination is the main tool. Careful palpation to map the most tender point, checking whether pressure there reproduces the burning, and testing whether pain extends toward the outer side of the heel.
- Ultrasound is useful for what it rules in and out around it — fascia thickness, a bursa, a partial tear.
- MRI can show changes in the small muscle on the outer border of the foot that this nerve supplies, which is suggestive when present. It is not present in everyone.
- Nerve conduction studies are technically difficult for this nerve and are not usually decisive.
A useful negative: an X-ray finding of a heel spur explains very little. Spurs are common in people with no heel pain at all, and their presence does not identify which structure is hurting.
What treatment looks like
Activity modification, calf and plantar fascia stretching, and control of the inward roll that crowds the nerve’s tunnel.
A firm heel counter, adequate cushioning and a device that supports the arch and reduces pronation. A soft gel heel cup alone often disappoints here, because the issue is a tight space rather than an impact.
If the fascia is thickened, it is part of what is crowding the nerve.
The same families used elsewhere. Options here.
Repeated steroid injections around the fascia carry their own risks and are not a plan on their own.
Reported results are reasonable when the diagnosis is right; the difficulty in this condition has always been the selection rather than the operation.
How it relates to the rest of this site
Baxter’s neuropathy is a mononeuropathy — one named nerve, compressed at one point — rather than the diffuse polyneuropathy most of this site is about. The distinction is explained here. That difference is good news: a single compressed nerve can improve a great deal once the pressure is relieved.
One important overlap. People with diabetes are more susceptible to compression neuropathies, because a nerve already under metabolic stress tolerates squeezing poorly. So a person can have a generalised diabetic neuropathy in both feet and a compressed Baxter’s nerve in one heel. When one heel is much worse than everything else, that asymmetry is the clue — it does not fit a symmetric polyneuropathy and deserves its own look. Reading the pattern is the whole skill here.
Common questions
How common is it?
Published series attribute a meaningful minority of chronic heel pain to entrapment of this nerve — commonly cited figures sit in the mid-to-high teens as a percentage. That makes it uncommon as a first thought and quite common among heel pain that has failed to settle.
Is it the same as tarsal tunnel syndrome?
Related but not the same. Tarsal tunnel syndrome is compression of the tibial nerve behind the inner ankle, higher up, and it usually produces symptoms across a wider area of the sole. Baxter’s involves one of its branches further along, and the symptoms are concentrated in the heel.
Will an X-ray show it?
No. X-rays show bone. A heel spur seen on X-ray is a common incidental finding and is not the diagnosis.
Can it cause numbness in the foot?
Usually not in an obvious way, because the area it supplies is small and overlaps with neighbouring nerves. The dominant symptom is pain of a burning character rather than a patch of numbness.
What should I ask if my heel pain is not improving?
Ask specifically whether nerve entrapment has been considered, where the most tender point actually is, and whether the pain has neuropathic features. Six months of unchanged heel pain is a reason to revisit the diagnosis rather than repeat the treatment. Questions to take with you.
Related reading
Types of neuropathy · The full symptom list · Foot drop and nerve localisation · Back pain versus nerve pain · Shoes and heel support · Which doctor to see
Sources and further reading: Baxter’s original descriptions of entrapment of the first branch of the lateral plantar nerve and subsequent surgical series. Published reviews of chronic plantar heel pain and its differential diagnosis. Imaging literature on denervation change in the abductor digiti minimi as a sign of distal tibial nerve branch entrapment. American College of Foot and Ankle Surgeons clinical guidance on heel pain.
This page is general education and is not a diagnosis or a treatment plan. Clinical review by Dr. Biernacki is pending; the review date will be shown here once complete.
For our Michigan neighbors
Heel pain that has not
moved in six months.
If plantar fasciitis treatment has not worked, the diagnosis is worth revisiting rather than repeating. Dr. Biernacki is a double board-certified foot and ankle surgeon and sees this every week.
Everywhere else, take this page to your own clinician.
Dr. Tom Biernacki, DPM, FACFAS is a double board-certified foot and ankle surgeon (ABFAS and ABPM) and a Fellow of the American College of Foot & Ankle Surgeons. He is the founder of Balance Foot & Ankle in Howell and Bloomfield Township, Michigan, where peripheral neuropathy, diabetic foot risk and loss of protective sensation are part of his weekly clinic. His patient education videos have drawn more than 950,000 subscribers on YouTube. He writes Managing Neuropathy to put the explanation he gives in the exam room in front of the people who cannot get to one — including when a product is worth buying and when it is not.