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Baxter's Nerve? DOCTORS...comments please

Posted by Brian on 2/17/01 at 21:41 (039285)

Quoted from an email to me, from a foot/ankle orthopod:

'The differential diagnosis of heel pain includes several items, most notably is PF. This accounts for an overwhelming majority of the patients. Another much less common is entrapment of the first branch of the lateral plantar nerve (nerve to digiti quinti minimi, sometimes called 'Baxter's nerve'- after Don Baxter the 1st one to describe this nerve entrapment as a cause of heel pain). Our literature is full of criticism of endoscopic PF release because it does not address Baxter's nerve.'

I was wondering if anyone had any comments on this. I have spoken to several orthopods (NOT podiatrists) who have said something very similiar to this. Why is it that most podiatrists will say that addressing the nerve is not necessary when doing PF surgery, but most orthopods will say that the nerve must be addressed?

I am not trying to stir anyone's emotions here. I am merely looking for a scientific explanation for this so that I have all of my facts straight in considering future options for my PF. Why not address the nerve? Even if you do an endoscopic partial resection of the PF, isn't there the distinct possibility that it will merely grow back together, or that the two transected ends will adhese themselves together? What about lateral plantar nerve entrapment post op?

I KNOW this is an ESWT board, but forget not, I have had ESWT twice and no relief and I am looking towards the future, which includes fact finding missions when necessary.

Respectfully,
Brian

Re: Baxter's Nerve? DOCTORS...comments please

Dr. Zuckerman on 2/18/01 at 06:39 (039297)

This is a which came first the chicken or the egg question. Some will even say that you should do a Tarsal Tunnel Release release. I do believe that if you are going to open the foot up then you should have all of the structures inspected the pf, spur if there, and all of the nerves.
There is an excellent article on all of the procedures in Podiatry Today .
Go to their web site and take a look at this article. It is in last months mag.

Re: Baxter's Nerve? DOCTORS...comments please

john h on 2/18/01 at 18:29 (039339)

don: i had the Baxter Procedure perfomed on my foot 18 months ago. My doctor as most doctors who trained under Dr. Baxter believe the PF pain is caused by inflamed fascia pressing on this nerve. The Baxter procedures involves cutting a simecurcular wedge of fascia about 1/2' out where the fascia attaches to the heel. This is directily over the Baxter Nerve. It is not a traditional release although you are in fact releasing about 1/2 inch of fascia from the heel. the incision is small and recovery is fast with little or no loss of foot stability as very little fascia is removed. Not many doctors are trained or do this procedure. Ther are two in my city both orthopedic foot and ankle surgeons. Carl Lewis the olympic runner had it done and went back to running. It will work for many and not for some but not as much downside as a release of 50% of your fascia. I am of course not a doctor but a patient who had the procedure so what i am saying is based on my experience and reading and discussion with the doctors who use this procedure. Dr Baxter is from Houston and is considered an authority on this subject.

Re: Baxter's Nerve? DOCTORS...comments please

john h on 2/18/01 at 18:44 (039342)

dr Z as you rember from looking at my foot my doctor did the Baxter Procedure on my foot and at the same time explored the nerve all the way up to 3' or more above my ankle. His only finding was a large vericose vein inside the tarsal tunnel. i personally do not believe the pain i experience where the fascia attaches to the heel on the inside of the foot would be caused by a nerve entrapped above the ankle. i would think there would be tingling and other sensations such as shooting pains,etc. My feet, even the one that was not operated on, continue at a pain level of 1.5 to 2.5. i am 70% better than 2 years ago. i think ESWT played an important part of my improvement as this has been ongoing for 7 long years. my electrical studies were somewhat positive but my doctor said these studies are very subjective and the electrical studies in themselves should be no reason to have a tts surgery. i agree with that! anyone considering tts should get at least 3 opinions because in this type surgery you can make things a lot worse and it is a difficult diagnosis. (all this is lay opinion-ck with your doc).

Re: Baxter's Nerve? DOCTORS...comments please

Dr. Zuckerman on 2/18/01 at 20:24 (039353)

Just a few weeks ago I had a patient that came to me due to continued pain after plantar fascia release surgery via EPF. He did have acute pain on palapation into the tarsal tunnel and the porta pedis area of the foot.

My impression was baxter's nerve or TTS or both . The young man was in serve pain . He didn't didn't have pain at the insertion it was distal and he had pain into the tarsal tunnel region.

Went for another opinion and he was told that it was his back. I sent the patient to this doctor. I asked the doctor who has alot of experience in rearfoot and ankle surgery why he didn't want to do the TTS exploration etc.

His reply was that the his results were very unpredictable. With this patients he really had no choice it was either a TTS exploration or live with the problem.

The point I guess is that TTS and baxter's release are very subjective diagnosis and very difficult to diagnosis
t

Re: Brian... help me out fella,

Kim B. on 2/18/01 at 23:40 (039367)

Excuse me, I can't answer your question, but maybe you can help me with mine... Do we have two Brians here or, is this Brian the same as Brian G.? I'm sorry, I get confused so easily. Would you mind using a last initial each time you post? It helps a lot of us keep the names and medical histories from blending together. So easily. I'm a bit of an old timer around here and if, I'm not mistaken, there are actually two new Brians here, that spell their name the same way. Please correct me if I am wrong. Thanks a bunch, we're glad you're here, btw.

Regards, Kim B.

Re: Brian... help me out fella,

Brian G on 2/20/01 at 21:05 (039514)

Not me, it's the other newbie :*)
I'm either BG or Brian G, with the 7 years PF, ugggg!!!

Re: Baxter's Nerve? DOCTORS...comments please

Dr. Zuckerman on 2/18/01 at 06:39 (039297)

This is a which came first the chicken or the egg question. Some will even say that you should do a Tarsal Tunnel Release release. I do believe that if you are going to open the foot up then you should have all of the structures inspected the pf, spur if there, and all of the nerves.
There is an excellent article on all of the procedures in Podiatry Today .
Go to their web site and take a look at this article. It is in last months mag.

Re: Baxter's Nerve? DOCTORS...comments please

john h on 2/18/01 at 18:29 (039339)

don: i had the Baxter Procedure perfomed on my foot 18 months ago. My doctor as most doctors who trained under Dr. Baxter believe the PF pain is caused by inflamed fascia pressing on this nerve. The Baxter procedures involves cutting a simecurcular wedge of fascia about 1/2' out where the fascia attaches to the heel. This is directily over the Baxter Nerve. It is not a traditional release although you are in fact releasing about 1/2 inch of fascia from the heel. the incision is small and recovery is fast with little or no loss of foot stability as very little fascia is removed. Not many doctors are trained or do this procedure. Ther are two in my city both orthopedic foot and ankle surgeons. Carl Lewis the olympic runner had it done and went back to running. It will work for many and not for some but not as much downside as a release of 50% of your fascia. I am of course not a doctor but a patient who had the procedure so what i am saying is based on my experience and reading and discussion with the doctors who use this procedure. Dr Baxter is from Houston and is considered an authority on this subject.

Re: Baxter's Nerve? DOCTORS...comments please

john h on 2/18/01 at 18:44 (039342)

dr Z as you rember from looking at my foot my doctor did the Baxter Procedure on my foot and at the same time explored the nerve all the way up to 3' or more above my ankle. His only finding was a large vericose vein inside the tarsal tunnel. i personally do not believe the pain i experience where the fascia attaches to the heel on the inside of the foot would be caused by a nerve entrapped above the ankle. i would think there would be tingling and other sensations such as shooting pains,etc. My feet, even the one that was not operated on, continue at a pain level of 1.5 to 2.5. i am 70% better than 2 years ago. i think ESWT played an important part of my improvement as this has been ongoing for 7 long years. my electrical studies were somewhat positive but my doctor said these studies are very subjective and the electrical studies in themselves should be no reason to have a tts surgery. i agree with that! anyone considering tts should get at least 3 opinions because in this type surgery you can make things a lot worse and it is a difficult diagnosis. (all this is lay opinion-ck with your doc).

Re: Baxter's Nerve? DOCTORS...comments please

Dr. Zuckerman on 2/18/01 at 20:24 (039353)

Just a few weeks ago I had a patient that came to me due to continued pain after plantar fascia release surgery via EPF. He did have acute pain on palapation into the tarsal tunnel and the porta pedis area of the foot.

My impression was baxter's nerve or TTS or both . The young man was in serve pain . He didn't didn't have pain at the insertion it was distal and he had pain into the tarsal tunnel region.

Went for another opinion and he was told that it was his back. I sent the patient to this doctor. I asked the doctor who has alot of experience in rearfoot and ankle surgery why he didn't want to do the TTS exploration etc.

His reply was that the his results were very unpredictable. With this patients he really had no choice it was either a TTS exploration or live with the problem.

The point I guess is that TTS and baxter's release are very subjective diagnosis and very difficult to diagnosis
t

Re: Brian... help me out fella,

Kim B. on 2/18/01 at 23:40 (039367)

Excuse me, I can't answer your question, but maybe you can help me with mine... Do we have two Brians here or, is this Brian the same as Brian G.? I'm sorry, I get confused so easily. Would you mind using a last initial each time you post? It helps a lot of us keep the names and medical histories from blending together. So easily. I'm a bit of an old timer around here and if, I'm not mistaken, there are actually two new Brians here, that spell their name the same way. Please correct me if I am wrong. Thanks a bunch, we're glad you're here, btw.

Regards, Kim B.

Re: Brian... help me out fella,

Brian G on 2/20/01 at 21:05 (039514)

Not me, it's the other newbie :*)
I'm either BG or Brian G, with the 7 years PF, ugggg!!!