#850 Medial calcaneal neuritis vs Baxter's neuritis in runners with heel pain - DOC

#850 Medial calcaneal neuritis vs Baxter’s neuritis in runners with heel pain

Today on the Doc On The Run Podcast we’re talking about medial calcaneal neuritis versus Baxter’s neuritis in a runner.



If you’re a runner with heel pain and you think you have plantar fasciitis and it’s not getting better when you treat it and you do all the right stuff to treat plantar fasciitis, well,  it might be another condition, and it could be inflammation of a nerve called neuritis. Inflammation of the fascia is called fasciitis but inflammation of the nerve is treated differently than inflammation of a ligament.

When you get inflammation of the nerve, what happens is you get swelling in or around the nerve and it causes pain, because the pain is going from the bottom of the heel where the nerve is then it often seems like plantar fasciitis and I do see lots of runners who had been misdiagnosed with plantar fasciitis.

Many times they misdiagnosed themselves and never saw a doctor but I do see runners who even saw doctors and they have this condition. And there are a couple of different nerves, one of them goes down the inside of the heel from the ankle and it curves around the bottom of the heel and that’s medial calcaneal neuritis. That’s the one I see the most.

But I was just giving a lecture to a group of physicians getting their continuing medical education credits at the International foot Medical Foundation medical conference in Lake Tahoe and I was giving a lecture called “When heel pain is not plantar fasciitis in runners”, and of course one of the conditions I was talking about was medial calcaneal neuritis and at the end of that session one of the doctors in the audience asked a really great question.

He said,  “I see a lot of people that have Baxter’s neuritis, and it’s down on the bottom of the heel it’s plantar , it’s not on the side of the heels, it’s not medial neuritis, it’s different. And he said “What would you do to tell the difference between these two conditions in a runner, given the circumstances you just explained in the talk?”

I said, “Well, that’s a great question.” The first thing I would do is I would probably, since I have an ultrasound unit, I would probably try to look at it and see if I could actually find the nerve or see inflammation in a spot where the nerve should be. And I would also look and see if there’s inflammation around the fascia or not. If there isn’t inflammation around the fascia, then it’s probably something else.

You can’t see that on an x-ray. So, when you go to the doctor and they take an x-ray of your foot, and they say, “Well, I don’t see anything. So, you have plantar fasciitis.” Well, that means you don’t have a thing you see on the bones. You don’t have a crack in the heel bone, but it could be bursitis, it could be neuritis, it could be fasciitis, it could be a partial tear of the fascia, it could be lots of different things. And this doctor was right, it’s not necessarily just medial calcaneal neuritis, it could be Baxter’s neuritis, a different nerve.

So, the first thing I tried to look at and see. It’s very difficult to see inflammation around those nerves though because they’re very small. I might not see anything at all. If I didn’t see anything at all, I would say “Well, why don’t we try something simple. Why don’t we try and experiment?”

The experiment I would do first would be a diagnostic injection where I would actually just take some local anesthetic that we use to make something numb and I would inject it right where the medial calcaneal nerve is and see if all your pain goes away. If all your pain goes away then there’s a problem with the nerve. If that doesn’t work, then you could inject Baxter’s nerve and see if the pain goes away in that spot.

There’s another way you could do this too even if you don’t have a doctor and that’s experimenting with lidocaine patches. If you take lidocaine patches, and you put it over the nerve, and it all calms down, well then it’s not the fascia, it’s the nerve and that’s an experiment you can run at home.

I actually show you how to do that in the runner’s heel pain course. But these are really simple strategies that you have to think about when you’re a runner and you have something simple like heel pain that you think is caused by plantar fasciitis, but you’re not getting better. And if you want to understand all the strategies I use with runners and the strategies I actually teach to physicians at medical conferences, you can get that for free if you join me in the runner’s heel pain masterclass, you can get that at www.docontherun.com/heelpainmasterclass. So, come check it out, and I’ll see you in the training.