Not what you're looking for? CLICK HERE INSTEAD



MRI vs EMG for Baxter's nerve

by Bessie
(Florida)

Baxter's nerve

Baxter's nerve

After xray and 8 weeks PT my podiatrist ordered an MRI for entrapped Baxter nerve diagnosis. PT said to have my neurologist do nerve test. He ordered an EMG for tarsal tunnel syndrome diagnosis. My podiatrist says the MRI is all I need.


I am scared of surgery and husband said we will get different docs diagnosis until someone says no surgery.

Having MRI next week and insurance won't cover EMG but will have it if it is needed eventually when I can afford it.

Is this something I should discuss with both my doctors?

Thank you

Bessie

RESPONSE

Hi Bessie,

Let me start off by saying that certainly you should discuss your treatment options with your any doctor involved in this particular problem as they are the most familiar with your situation.

Having said that I do have a few concerns based on your narrative and I would like to address them.

According to you, it seems like all you had so far was an x-ray and some physical therapy; hardly what I would call any real treatment for a possible Baxter's nerve.

Baxter's nerve is an irritation of one of the branches coming off the medial plantar nerve. (the red arrow is pointing to Baxter's nerve on the bottom of the heel).

It is a diagnosis that is generally not too difficult to make just by examination. In most cases there will be pain when the doctor presses on the inside of the heel, even though your actual pain may be on the bottom of the heel when you walk. This same pain is usually not evident on pressing in the same spot on the other foot.

Additionally, there may be some degree of numbness on the bottom of the affected heel compared to the other heel. This can be identified by using a dull pin and pressing against the bottom of each heel, the affected heel will be duller than the other heel.

In most cases of a heel neuroma (Baxter's nerve) the heel will become more painful, the more you walk. This is in contrast to plantarfasciitis which is most painful on initial ambulation and then eases up as you walk.

The reason a heel neuroma will worsen as you walk is because the pounding of the heel during ambulation will aggravate the nerve and make it worse.

In my mind at least making the diagnosis of Baxter's nerve is not that difficult. I have found it rare in my practice that people just have Baxter's nerve issues; I tend to find that they run concurrent with plantarfasciitis.

Plantarfasciitis tends to be easier to treat and when patients end up having prolonged pain that does not respond to the usual therapies for plantarfasciitis, it is usually due to a heel neuroma or even a heel bursitis.

Moving along, one of the problems with a heel neuroma is that it may actually be a tarsal tunnel (the foot equivalent of carpal tunnel seen in the hand), where the nerve further up the foot at the level of the ankle becomes entrapped and can give symptoms such as heel pain as well as more diffuse pain in the foot.

Now, you podiatrist wants to do an MRI and states that is all you need. The problem with an MRI is that I have found them to be poor prognosticators of neuromas.

In theory they should be able to identify enlarged nerves but in my experience they tend to give too many false negatives, meaning they do not find neuromas when one actually exists.

I can tell you of multiple instances over my career where I have had an MRI that came back negative for a Morton's neuroma, which is a neuroma in the forefoot, only to go in surgically and actually remove a neuroma.

In theory, an MRI should be able to reveal nerve entrapment found in tarsal tunnel, but an EMG, at least in my opinion would be the better test.

Having said all that, if you were my patient, at this point I would not be ordering any tests without actually have given you some specific treatment, besides physical therapy.

One of my favorite treatments for heel neuromas is the use of 4% percent denatured alcohol injections given weekly for upwards of seven weeks. What this injection does is sclerose or deaden the nerve and in doing so, reduces or eliminates the heel pain of a heel neuroma.

There are additional treatments that are mildly invasive that can be done for your heel pain such as injected CO2 which essentially freezes the nerve to keep it from hurting.

The amount of fat that you have on the bottom of your heel may also be a factor is heel neuroma. I do not know how old you are but as we age the one area where we lose fat is on the bottom of the foot. Some younger individuals also exhibit very little heel fat.

The problem here is that without much fat to cushion the area, Baxter's nerve is constantly being irritated by walking. Thus, in many instances adding a heel cushion to deaden the impact of heel strike when walking may go a long way in reducing symptoms.

At this point in time I do not think you are a candidate for surgery, certainly not without having tried some less invasive therapies. It may turn out that even after some of these treatments, if you are still in enough pain, then a surgical procedure may be indicated.

In closing, discuss all this with your doctor(s). You should always be part of the decision making process since it is your foot. If you find that you end up being at odds with what your doctor recommends, then seek out a second opinion with a doctor in your area.

Marc Mitnick DPM
DISCLAIMER

Comments for MRI vs EMG for Baxter's nerve

Average Rating starstarstarstarstar

Click here to add your own comments

Apr 13, 2015
Rating
starstarstarstarstar
EMG AGAIN!
by: Bessie Mae

Had another painful EMG Nerve test today which nerves and muscles are working fine. No tarsal tunnel either. This doc specializes in these and gives you the results right away. Unlike the last one, he also did the bottom of my feet and my lower back. This time I did not bleed either. Still quite painful in the calves and thought my leg was gonna jump off the table when the electrode hit. He said my pain is orthopedic. Looks like I am back to the starting gate. One and a half years, creams, injections, various prescriptions, 40 weeks of therapy, wearing a boot, compression stockings and still wearing shoe inserts for plantar faciitis. Got a feeling this pain is simply something I am gonna have to learn to live with. Arthritis on left side of spine and bulging disks on right side. Rheumatologist is talking spinal injections and we are hopeful it will at least get me moving more.

Aug 27, 2014
Rating
starstarstarstarstar
Therapy
by: Bessie Mae

After only one PT session with electrical stimulation, ultrasound, contrast bath, slant board, and soft tissue massage my left foot responded 90% and right foot 75%. Less pain during todays session and almost no grinding feelings in left foot at all. I still don't understand why the other PT did none of these for the 8 weeks I went, but I am too grateful to complain (today). The Orthopedist gave me a softer orthotic for my right foot and tomorrow I iron clothes for hours which is a true test. Thanks again doc for having this website and we STILL need qualified Podiatrists in beautiful sunny Tampa Bay (Bradenton) Florida.


Thank you and good luck.
Marc Mitnick DPM

Aug 26, 2014
Rating
starstarstarstarstar
New Diagnosis
by: Bessie Mae

Went to a doc who is not in my insurance network, meaning it's gonna cost me more. My husband used him in the past and PT there for years (seemed like it). We trusted him enough with our daughter so kiddos said I can spend their inheritance on my feet. Plantarfaciitis. The PT said my symptoms for this would not always be the same as my husbands since he is flat footed and I have very high arches. Their goal is to teach me how to walk properly so I don't wobble as much and they think the extreme pain I had on my fifth toe is actually a fracture caused by the way I put all my weight on the outside of my foot so the arches don't hurt. He put the orthotics inside my shoe while I was there and said I am not to remove them. Worth a go since the other doc wanted an MRI of the wrong foot.

Jul 05, 2014
Rating
starstarstarstarstar
PF
by: Bessie Mae

New doc messed up on MRI order so went to Good Feet. May as will give more inserts a try. PF according to them. Did I mention the great weather in Florida doc? Barefeet on beach needs reliable podiatrist.

Jun 18, 2014
Rating
starstarstarstarstar
Results
by: Bessie Mae

Results from Nerve Test and EMG came back normal. Neurologist explained my pain as neuropathy even though results said no. I am more confused now than before. He said the results are like listening to a trio singing. A big loud voice which is heard, a middle size medium which is heard less but still heard, and a small quieter voice drowned out by the other two so the test could not hear it. Like I said, I am now more confused.

Jun 03, 2014
Rating
starstarstarstarstar
EMG
by: Bessie Mae

EMG results is no tarsal tunnel. I don't remember what he thought the problem is. He says I should see a podiatrust as he does not see how an orthopedist could help. Test was painful and I am very sore now but at least I know what IT isn't. Next step is finding a new doc. Weather is Florida is great Dr. Marc.
I will continue my search but if all else fails, OTC meds aplenty.

May 28, 2014
Rating
starstarstarstarstar
MRI vs EMG
by: Bessie Mae

Insurance denied MRI again. Doc forgot to tell them I had an xray of left foot, injection in left foot, prescription compounding cream for both feet 3 times daily for 2 months so far, and 5 weeks PT for both. I cancelled EMG until someone else can drive since it is for my rigt foot. I also have concern with a Chiropractor doing the EMG when a radiology lab can do the same thing. The pain has now progressed to include my heels. Hoping it is a mental thing on that one since everything I read includes heel pain. After a short camping vacation trip where all we do is walk I will be heading back into fixing my feet.
Lesson to readers, if you fall, don't assume if you can still move it you don't need to have a medical professional look at it. I regret not going to my primary doctor for referrals, at least that way maybe the insurance company would treat this as one injury and PT could have been done immediately.

Hi Bessie,
Your last paragraph is great advice to people visiting this site. In general, if an injury does not show substantial improvement within lets say 3-5 days, then in most cases it could be a sign of a more serious injury. The earlier an injury is treated, the better the outcome. Hoping an injury gets better on its own is not a sound medical strategy.
If you are going to have an EMG, a neurologist is the one to do it. Just so I do not get nasty comments from chiropractors, I do doppler studies in my office for circulation issues, but they are more of a "screening test". Ultimately, if I suspect poor circulation, I send my patients to a vascular specialist for follow up and confirmation.
Good luck to you.
Marc Mitnick DPM
ps: have your doctor call the insurance company again and mention all the previous treatments you have had; in most cases that should be enough to approve an MRI.

May 22, 2014
Rating
starstarstarstarstar
Thank You
by: Bessie

Thank you so much for your response. Indeed my pain is not in my heel and since both doctors have negative opinions of each other's diagnosis it is time to seek out an unbiased party. I forgot to mention I did have one injection in my left foot and my podiatrist did not do an xray of the right foot which is a different and more pronounced pain.
Tank you again.

Click here to add your own comments

Join in and write your own page! It's easy to do. How? Simply click here to return to Ask the doctor.






download from Apple Store
Get it on Google Play



MY PRODUCT RECOMMENDATIONS
(items I prescribe in the office)


Orthotics for multiple types of foot pain
best buy in a pre-made orthotic
click link below


SuperStepOrthotics


Orthotics for heel and arch pain for those who must wear dress shoes
click link below


redithotics


Topical pain reliever
click link below


blu-mjk


Relief for nail fungus
click link below


clotrimazoil


HONESTe Online Member Seal
Click to verify - Before you buy!






I've been doing some aggressive research lately (it's how I found your incredible website) and realize now that my symptoms are not consistant with the diagnosis.

Jennifer

Hunterville, NC
….after reviewing your amazing site (great for the avg. jill). So thank you very much!!!

Liesbeth

NY
I am really, really impressed with your plain-speak explanations for the various conditions.

Jacqueline

NJ
This was an extremely helpful site. I have an appointment on the 18th and your info. Was right on target…..

Jack

Fla
A well organized site containing much information written in a manner that the average reader can comprehend.

Jean

Ontario, Canada
I found your website and articles most interesting.

Andrew

Fla.
Thank you for a quick response. I think your site is the best information site on foot pain and I have viewed many.

Judy

(location unknown)
I came to your website, footspecialist.net via www.foot-pain explained .com which I think is also your website? I thought explanations for different types of problems were well addressed and thoughtfully stated for the patient in mind.

L.W.

New York
You have an amazing and extremely informative site. I enjoyed looking through all of the data and stats.

Yvette

Memphis, TN
Thanks again so much for the information in the article. Very interesting.

Anna

Scotland
Great article. I have had plantar fasciitis since I was in high school……..

J. Simmons

(location unknown)
Dear Dr. Mitnick, The orthotics arrived four days ago and I slipped them into my shoes immediately. I was skeptical as to the usefulness of the item, they really didn't look very exotic. I have to say though, after using them for just four days, I have experienced grand relief from my foot pain. Even the very first day, I was able to do a lot of work while on my feet with at least a 75% reduction of pain. It has only gotten better every day, and I go nowhere without my shoes with the orthotics. I had been experiencing extreme heel and sole pain for about six months and had to take extended breaks off my feet many times a day as well as regular doses of Ibuprofen. Since getting the orthotics, my life has returned to normal and I feel good again. Just wanted to say thanks for the recommendation for a very effective item, I had no idea what a change this item could affect.

Yours truly,

J.C. Forbes

Tennessee
Thanks for the Response, you hit it on the head.

Steve

Redondo Beach, CA
Thank you for your time and expertise in answering my question…..

LH

(location unknown)
First, thanks for putting together this website. Its the most informative site I have found dealing with foot problems. Last June I started having pain and swelling at …….

Joe

(location unknown)
First of all, thank you for having all this useful information available in one place. I've been through most of your website and based on my research, pain and evaluations I think I've narrowed things down quite a bit.

Pete M.

(location unknown)
Thank you for the best site I have found when researching foot pain.

Glenda B.

Madison, Alabama
Thanks for replying so quickly. I was a bit concerned. I think your website is great, and chock full of info.....

Carol

Denison, TX
Dr. Marc, Thank you so much for your reply which seemed to be right on. I have researched many sites but you put me on the right path to the possible answer. My foot pain may not rule the rest of my life after all! I believe I'll make a sign that reads, "THE END IS NEAR!" Thanks Very Much,

Dawn

West lafayette, IN
Dear sir...no doubt you get positive comments re your site...May I please be added to the list of your admirers. In all of my years of web surfing I would say your site is right there with the very best. Thank you for taking the time to write the terrific info you provide and for putting things into laymen terms for us mere mortals. I pray you have much on going success and thank you again for a deed well done. As for me I did not find much help for my symptoms and will continue on my quest. Were you anywhere in the South I would make and appointment...Thanks again dear sir...m.e.

Michael E.

Tampa, Florida 33624
Hi. This is a great site! I'm a healthy middle aged woman who is in good health, but.....

Kelly

Texas
Just a wee word of thanks for your wonderful website...It is a terrific service...Thank you for providing your knowledge and help...With highest regards, m ebeling

Michael D. Ebeling

Tampa, Florida 33624


Thanks for a most interesting website, which has helped a lot.

Steve

UK


Dear Dr.Mitnick

I usually do my research on the Mayo clinic website. I think your website is the most informative site I have found when researching foot pain.

I thank you for putting together this incredible website.

Regards,

Dragica W.

Edmonton,Canada


....I have been told that it is not hard enough to be cut off. Please help, I am not sure what to do now! THANKS FOR A WONDERFUL AND VERY HELPFUL SITE!

Roxy

South Africa


You have an unusually clear, informative and well-written website for laypersons. Thank you for that.

Matthew W.

Mansfield Ctr, CT


First, I'd like to thank you for all the information that you provide on your website and the opportunity to write to you.

Steve

Placentia, California


First, I want to let you know that you have the best web site I've found related to foot issues. (The only thing I had difficulty finding was the "ask a question" page.)

Unknown

Unknown location


I received the orthotics Monday afternoon and began wearing them Tuesday. After two days I would say that I have noticed a huge improvement in the discomfort I have been experiencing. My foot feels better than it has in months.

Ric J.

Unknown location


I greatly admire someone like you who would donate and dedicate so much time and effort to helping strangers with no compensation. Truly, it is uncommonly kind. And your site is so intelligently arranged.

Ron R.

Pacific Grove, CA


I used to work for a podiatrist (front desk) back during summers in college years ago, so I know the benefits of good care. Again, I want to thank you for an EXCELLENT website. It was so great to get to your site (top of google search) and actually find all the answers I needed EASILY and QUICKLY! Clearly you put a ton of work into it and I really appreciate it.

All the best,

Victoria

Alameda, California


By the way, millions of websites could use yours as a guideline on how to organize information and make the site user-friendly. Kudos to you!

Anonymous


Thank you for your very interesting and informative site!

Anonymous




Hi. I come to your site often looking for information. It is really informative and I appreciate it very much. I have RA and have been having considerable amount of foot pain...... Dee RN


Thanks very much for the wonderful informative site.

Catherine

New Zealand


Thank You for my answer! I have been schedule for a bone density scan, allingment, and I am in the process of getting orthotics made, and checking out the natural remedies. Thank again! What a great web site!

Sincerely

Josette


Yes I want both pair of orthotics. You don't have an option of ordering 2 at one time so I had to place the order twice. Thanks. My husband likes these and wants to put them in all of his shoes. (referring to Superstep orthotics)

Cindy H.

Arizona
I searched the internet everywhere for a clear description and illustration of my symptoms/problem. http://www.foot-pain-explained.com/ was where I ended my search with answers. If I lived in Jersey (left 30 years ago) and didn't live in Florida I would definetly make an appointment with Dr. Mitnick.

Thanks, Kathy

Florida
1st of all THANKS A LOT for your great site......

Anna

Poland
Thank you so much for your response. I will let you know how I am doing if you would like. Your website is awesome!

M P

South Carolina
Hello! I want to thank you for such an informative website! I found you based on my ankle pain search and am happy to realize that there may be a relatively simple cause and solution....

Natalie

unknown location


...Thanks for your fantastic service.

Gary

Arlington, VA


Thank you so very much, that would be much appreciated. I love those insoles, by the way. (referring to Superstep orthotics)

Kelly W.

San Clemente, CA


Dr Marc is fantastic...He seems to know exactly what you are feeling with the problems you are having. I wish he was in my home town so I could go to him with my problems!!!!!!!!!!!!!

Pam

location unknown


Great insights! Thanks Doc, you're the best.

Glen

location unknown


I have been experiencing foot pain of various sorts and am working to figure out what it is. I found this site and can only say BRAVO!! What an excellent site! The time it must have taken to put all this together must've been a daunting task! I am sure it has helped so many people. Thank you so very much for doing this.

Bre

location unknown


Dr. Mitnick, Thank you so much for your reply. I did let my physician know and they took an x-ray - all is well! Also, thank you for providing this wonderful site, it is very helpful with lots of useful information! I appreciate your gift of time! God bless.

anonymous




Dr. Mitnick, Thank you, you were 100% correct. The pain finally brought me to the ER. I spent 8 days in the hospital. The Doppler you spoke of was able to show that there was no pulse in that foot. This was an arterial clot that split and traveled throughout my leg. My leg was almost amputated. I am in rough shape but have all my parts intact!! You certainly know what you are talking about. Thank you for taking the time to answer. Yours Truly!

anonymous




Staying at home after hallux surgery I spend quite a lot of time seaching info useful for avoiding problems which might come back. Today I found your site and I am .... delighted it happened. It's one of the best site I found last days.

Anna

Poland




Thanks for taking time to read and answer so many questions. It is truly a public service!

Esh

Seattle, WA


I just wanted to say that I am very greatful for this website!!

Bonnie

location unknown




Also, and importantly, just want to praise this web site. Thorough and thoughtfully presented, it certainly must be of considerable assistance to anyone with a foot problem. Terrific -- and very interesting.I trust the address comes up easily for those seeking information.

Bill

New Jersey




Thanks so much for answering my question. You've been more help to me than my own Dr. has been lately. Thanks again....I hope to be able to walk without pain someday.

Debbie

location unknown




Wow, that is exactly the information needed!!! thank you thank you thank you!!! I appreciate this help so very much from Marc Mitnick DPM. Excellent information and help to improve One's life.

Chrissy

location unknown




Thanks so much for this website Dr. Marc! It is so nice that you have this ask the doctor feature..I'm sure I'ts been helpful for alot of people. I will try what you suggested and see if it helps...thanks again!

Tracy

Evansville, IA




Dear Marc

I just want to say thank you for the quick response and the good info. I find it amazing and a super nice thing that you do here by answering medical questions at no charge.

Russ W.

location unknown




Your website is full of a lot of helpful information, and I am very impressed with the time in which you responded to my post. Thank you again for your time and consideration in your response.

-Sunny.

location unknown




Thank you very much for the information, I will consider it. Excellent web site.

Jackie

San Diego, CA




Dr. Mitnick, Just want to say thank you so very much for your quick response and very informative reply! After reading what you had to say, I called the doctor's office and was able to get in and see him the same day as my injury. Toe was x-rayed and luckily, it is not broken or fractured. Very badly bruised and will probably lose the toe nail. And although my toe and toe nail are still very black and blue and very sore, they ARE both starting to feel a little better. So again, thank you! I am so very happy that I came across your website. The service you provide is outstanding and immeasurable!

Rivi,

Albany, NY




Thank you so much for all of your advice. In searching the web for people dealing with this same issue i can tell you that you are a Knight In shining Armor! If I lived in Jersey I would gladly be your Spokesperson. Hopefully next time you hear from me it will be good news. God Bless,

Jill S.

location unknown




THANK YOU SO VERY MUCH FOR YOUR TIME AND EFFORTS, YOU ARE SO VERY APPRECIATED. THANK YOU FOR ALL YOU DO.

Jackie

Whichita, KS




thanks again, this site is very helpful.

mark

Boston, MA




Like others have stated...This site is amazing and I am so thankful that it was created.

....Keep up what your doing. Your a life saver.

Michelle

Colorado




Thanks again for the information provided on your site. It's easy for non-medical folk to understand your writing, and helps provide better communication between patient and doctor.

annielou

Colorado


Wonderful advice

by: Anonymous

This is the best site for foot problem info.


Thank you for this information. This description fits my pain and inflammation behind my 2nd toe perfectly.

by: Max

location unknown
Again, I really appreciate that you responded to my inquiry, and that your mention of Parkinson's helped me to find my way to a diagnosis of this difficult to diagnose disease. Most patients see on average 16 doctors before they are diagnosed. I hope that you can help other people that ask for your expertise in the future.

Barb D.

Canada
I just wanted to say that I am very greatful for this website!! I have had a fusion in my rt foot and am finally getting a little bit better......

Bonnie

location unknown
Again, Thank you from the bottom of my heart for taking the time to answer my question....your an angel!

Nancie

Wisconsin
Thank you for your response. You have provided some great insight (to my question)....

Julie

location unknown
Thank-you so very much for responding so quickly and in such detail to my question!! I will give my surgeon a call today!! This website is terrific!!!! Thank-you again!

Renae

North Carolina
Many Thanks Dr Marc!
Thank you for your response. It sounds like a good plan to me. He did not cut the wart out first ...

KG

location unknown


Thanks again doc for having this website and we STILL need qualified Podiatrists in beautiful sunny Tampa Bay (Bradenton) Florida.

Bessie Mae

Florida
Dear Dr. Mitnick, Thank you so very much for taking your time to answer my question. You have greatly relieved my anxiety related to the continual tingly I feel in my feet. I will share your response with my podiatrist next week. God bless you for having this question and answer page on your website! Most gratefully,

Lynne T.

location unknown
Your webpage is excellent, I commend you on sharing your knowledge to the public.

Robert

New Jersey


Thank you. you were more detailed than what others have told me they finally called from the last xrays and my son is now in a cast for 2 weeks he did have a fracture that was not noticeable.

a mom

location unknown


I have read your website and I have to admit that I am amazed at all the information that is on here. I have learned more than the three years I have been going to several doctors that I have seen!!

Melody

Lenoir, NC


Thank you so much Doc for a quick and thorough response!

Rustam

Bellevue, WA


I cannot thank you enough for your response, opinion, and suggestions! I want you to know how much it means to me, and I'm sure everyone else who has ever asked you a question! I feel like you're a lifesaver and have empowered me to take a stronger role and stand up for myself and my feet!

Jodi

location unknown