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The response to the question below was authored by Marc Mitnick DPM
Baxter neuropathy
by Crystal
(Ellensburg Washington )
Had plantar partial release and gastrocnemius release in march 2018 on both feet and legs prior to surgery tried everything insoles therapy shock therapy massage stretches insoles ice rest 3 cortisone injection which help and took pain away for about 6-12 hours pretty much till the numbing lidocaine wore off, nothing helped so opted for surgery. It's been 19 weeks and my heels are so painful I get a couple hours into work and I'm miserable and it just gets worse. new doctor sent me for emc/mcc test did on Friday shows baxters neuropathy moderate to severe on left foot and severe on right foot what is your suggestion for treatment? Since original surgery in March I've done physical therapy, stretches, rest, ice, tens unit, inserts, insoles, taping, nothing helps.
RESPONSE
Hi Crystal,
I do not like playing monday morning quarterback and of course I have never examined you, BUT, it would not surprise me at all if your Baxter's neuroma was your problem all along. They just don't pop up after surgery, unless there was damage to the nerve when you had your partial release of the plantar fascial ligament. I cannot imagine though, your surgeon would have hit the nerve on both feet.
Baxter's neuroma or heel neuroma is very often overlooked when diagnosing heel pain. When a patient presents to my office with heel pain and they tell me the pain worsens the more they are
I say this, because plantar fasciitis itself will tend to hurt when you first stand up on your feet, like when you get out of bed in the morning, but as you walk around you gradually stretch the tight ligament and the pain begins to subside. Heel pain that then gets worse the more you walk on it, tends to be coming from another source.
The treatment for a heel neuroma has to be aimed at "deadening" the nerve. There are various treatments out there, but the one I use in my office is a series of injections of denatured alcohol, which over the course of injections deaden the nerve, so that you no longer have pain.
I have been doing these types of injections for over ten years and by and large have had good success with them.
Physical therapy where they do things other then stretching the foot, such as cold laser or ultrasound or other physical therapy modalities may also calm down the affected nerves.
There are other invasive treatments out there where the nerve is either frozen or heated up in an effort to deaden the nerve.
What I would suggest is, speak to your new doctor about what he or she would suggest. Apparently you have found a doctor who knows what they are doing.
Marc Mitnick DPM
DISCLAIMER
ADDITIONAL REFERENCES
University of Rochester Medical Center
American Academy of Pediatrics
Columbia University Department of Rehabilitation
Illinois Bone and Joint Institute
University of Maryland Medical Center
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