Importance of differential diagnoses for heel pain: baxter s neuropathy a case report

Abstract

Baxter’s neuropathy is characterized as a neuropathy caused by compression of the inferior calcaneal nerve. It is responsible for 20% of chronic heel pain and is often overlooked due to the various etiologies in this region. The objective of this work is to describe a patient with heel pain diagnosed by imaging as Baxter’s neuropathy and to provide a brief literature review on the topic, including differential diagnoses. CASE REPORT A 42-year-old married woman with two children has a 7-month history of mechanical rhythm pain in the lateral ankle region, associated with local edema and burning sensation. She underwent corticosteroid infiltration, IM vitamin, non-steroidal antiinflammatory drugs (NSAIDs) applications, and physiotherapy without improvement. Her past medical history includes prediabetes managed with 1 g per day of metformin. On physical examination, she had pain upon mobilization of the hip and ipsilateral left leg. Complementary examinations including lower limb Doppler and ankle ultrasound showed no alterations. An magnetic resonance imaging (MRI) of the ankle revealed fibrosicatricial changes in the anterior talofibular ligament, slight thinning sequelae of the distal calcaneofibular ligament, tenosynovitis, and liposubstitution of the abductor hallucis muscle belly compatible with Baxter’s neuropathy. Pregabalin 75 mg at night was prescribed. After 3 months, the patient returned with a 90% improvement in the painful condition. CONCLUSION Various diseases are part of the differential diagnosis for heel pain, such as Baxter’s neuropathy, calcaneal stress fractures, tarsal tunnel syndrome, tumors, and S1 radiculopathy. Therefore, Baxter’s neuropathy should be considered in patients with mechanical character heel pain associated with weakness of the abductor digiti minimi muscle, with reduced strength caused by muscle degeneration. A quick and accurate diagnosis is essential for a better prognosis and resource savings