Letter to the Editor
Hindfoot Pain: Baxter Neuropathy
Dolor en retropié: neuropatía de Baxter, a propósito de un caso
Marina Soledad Moreno Garcíaa,
, Pilar S. del Río-Martínezb, Nerea Yanguas Bareac, Pablo Baltanás Rubiod
Corresponding author
a Servicio de Reumatología, Hospital Reina Sofía, Tudela, Navarra, Spain
b Servicio de Reumatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
c Servicio de Radiodiagnóstico, Hospital Reina Sofía, Tudela, Navarra, Spain
d Servicio de Anestesia y Reanimación, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
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"apellidos" => "del Río-Martínez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Nerea" "apellidos" => "Yanguas Barea" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Pablo" "apellidos" => "Baltanás Rubio" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital Reina Sofía, Tudela, Navarra, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Radiodiagnóstico, Hospital Reina Sofía, Tudela, Navarra, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Anestesia y Reanimación, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Dolor en retropié: neuropatía de Baxter, a propósito de un caso" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 592 "Ancho" => 950 "Tamanyo" => 70342 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A T1 nuclear magnetic resonance sequence showing fat replacement of the abductor muscle of the fifth toe, and several dilated or varicose veins on the inner aspect of the foot, along the course of the inferior calcaneal nerve, suggesting Baxter entrapment neuropathy.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We wish to report the case of a 69-year-old woman, an ex-smoker, with no known allergies. She had been treated for plantar fasciitis secondary to a calcaneal enthesophyte 4 months earlier by her primary attending physician. She was referred to rheumatology because she had a 2-month history of what appeared to be a mechanical pain in left ankle. She had had no previous injury and had not improved with the treatment prescribed by her primary attending physician, who had begun with an nonsteroidal anti-inflammatory drug and an oral glucocorticoid. The physical examination revealed the pain in her heel and medial malleolus, with no swelling or reddening. There was no pain, swelling or functional limitations in the Achilles region.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Given the suspicion of noninflammatory involvement, and with the radiograph showing the calcaneal enthesophyte, nuclear magnetic resonance showed substantial atrophy with fat replacement of the abductor muscle of the fifth toe, and several dilated or varicose veins on the inner aspect of the foot along the inferior calcaneal nerve (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), compatible with Baxter entrapment neuropathy.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The differential diagnosis involves heel pain, so common in our clinics, which includes a wide range of diagnostic and therapeutic possibilities depending on the cause of the pain. Those of neural origin include tarsal tunnel syndrome which, although is not very frequent, it should always be considered in the differential diagnosis of the person with a painful ankle.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> To understand this syndrome it is necessary to be familiar with our anatomy.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> The posterior tibial nerve has 3 terminal branches: the medial calcaneal nerve, the medial plantar nerve and the lateral plantar nerve.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> The latter is the origin of the so-called Baxter nerve, which innervates the lumbrical muscles, the abductor halluces and the abductor of the fifth toe.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Entrapment of the first branch of the lateral plantar nerve, known as Baxter neuropathy, is the cause of 20% of cases of persistent hindfoot pain.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> It is often difficult to distinguish it from that produced by plantar fasciitis or calcaneal enthesophyte.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">4,5</span></a> The diagnosis is normally based on clinical findings, like the presence of paresthesias or tingling in the medial portion of the foot or the perception of pain while pressuring the course of the nerve.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">6,7</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Thus, a detailed medical history and thorough examination are essential to differentiate Baxter neuropathy from other conditions that affect the heel. With regard to imaging studies, nuclear magnetic resonance is the technique of choice.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a> It shows the isolated atrophy of the abductor <span class="elsevierStyleItalic">digiti minimi</span> muscle as a sign of chronic entrapment of the lateral plantar nerve, suggesting the diagnosis of Baxter neuropathy.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Entrapment can be due to biomechanical disorders, such as high arches or flat feet as well as to direct compression, such as plantar fasciitis, masses and/or calcaneal osteophytes.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a> Treatment includes conservative therapy and surgical management of the cause if the latter is not effective.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Discomfort produced by peripheral nerve entrapment is common in our clinic. Baxter neuropathy is the entrapment of the first branch of the lateral plantar nerve (Baxter nerve), often difficult to distinguish from that produced by plantar fasciitis. Thus, the management of this disorder requires knowledge of anatomy and of the clinical signs.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Moreno García MS, del Río-Martínez PS, Yanguas Barea N, Baltanás Rubio P. Dolor en retropié: neuropatía de Baxter, a propósito de un caso. Reumatol Clin. 2017;13:123.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 592 "Ancho" => 950 "Tamanyo" => 70342 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A T1 nuclear magnetic resonance sequence showing fat replacement of the abductor muscle of the fifth toe, and several dilated or varicose veins on the inner aspect of the foot, along the course of the inferior calcaneal nerve, suggesting Baxter entrapment neuropathy.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Variantes anatómicas del nervio calcáneo medial y nervio de Baxter en el túnel del tarso" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "X. 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| 2022 December | 90 | 50 | 140 |
| 2022 November | 116 | 53 | 169 |
| 2022 October | 110 | 50 | 160 |
| 2022 September | 98 | 53 | 151 |
| 2022 August | 98 | 63 | 161 |
| 2022 July | 102 | 50 | 152 |
| 2022 June | 114 | 65 | 179 |
| 2022 May | 96 | 59 | 155 |
| 2022 April | 87 | 61 | 148 |
| 2022 March | 109 | 63 | 172 |
| 2022 February | 89 | 52 | 141 |
| 2022 January | 148 | 53 | 201 |
| 2021 December | 102 | 59 | 161 |
| 2021 November | 96 | 69 | 165 |
| 2021 October | 128 | 65 | 193 |
| 2021 September | 96 | 51 | 147 |
| 2021 August | 87 | 55 | 142 |
| 2021 July | 97 | 28 | 125 |
| 2021 June | 102 | 35 | 137 |
| 2021 May | 133 | 44 | 177 |
| 2021 April | 279 | 84 | 363 |
| 2021 March | 164 | 43 | 207 |
| 2021 February | 144 | 33 | 177 |
| 2021 January | 148 | 35 | 183 |
| 2020 December | 87 | 33 | 120 |
| 2020 November | 120 | 29 | 149 |
| 2020 October | 116 | 16 | 132 |
| 2020 September | 110 | 35 | 145 |
| 2020 August | 78 | 33 | 111 |
| 2020 July | 82 | 25 | 107 |
| 2020 June | 77 | 28 | 105 |
| 2020 May | 34 | 19 | 53 |
| 2020 April | 34 | 25 | 59 |
| 2020 March | 17 | 10 | 27 |
| 2018 December | 2 | 0 | 2 |
| 2018 September | 0 | 1 | 1 |
| 2018 May | 7 | 0 | 7 |
| 2018 April | 59 | 10 | 69 |
| 2018 March | 122 | 9 | 131 |
| 2018 February | 34 | 4 | 38 |
| 2018 January | 70 | 7 | 77 |
| 2017 December | 39 | 9 | 48 |
| 2017 November | 41 | 9 | 50 |
| 2017 October | 41 | 8 | 49 |
| 2017 September | 23 | 17 | 40 |
| 2017 August | 28 | 13 | 41 |
| 2017 July | 31 | 18 | 49 |
| 2017 June | 37 | 15 | 52 |
| 2017 May | 49 | 35 | 84 |
| 2017 April | 56 | 54 | 110 |
| 2017 March | 41 | 32 | 73 |
| 2017 February | 1 | 6 | 7 |
Show all
