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The response to the question below was authored by Marc Mitnick DPM

Baxters Nerve Entrapment

by Roxanne
(Seattle)

I have been experiencing severe pain in the arch of my foot.(this has been going on for over 2 years, I badly sprained my ankle and it has never recovered) It continuously burns at rest and even more so walking around. I have seen many Dr's in the Seattle area who seem to have different opinions regarding nerve release surgery. The majority of the Orthopedic Dr.'s indicate absolutely do not have this surgery! They their is no scar tissue on the MRI and the NCV is normal. The DPM's want to try surgery and believe you don't need a negative NERVE CONDUCTION STUDY or show scar tissue on the mri. I don't know who to believe! I am in a lot of pain however I have no numbness in my foot or toes. The Orthopedic DR.s out here adamantly believe surgery will make my condition worse!

Any more thoughts on this painful problem?

Thanks,

Roxanne
Seattle

Hi Roxanne,
I would consider denatured alcohol injections before I would consider surgical intervention, along with physical therapy. The nerve is inflamed probably from the trauma, so the injections and physical therapy should calm down your symptoms. You do not have to have scar tissue in order for the nerve to be inflamed.
The risk you run from surgery is that you may end up with scar tissue.
Try the conservative route first.
BTW, have you consulted with Dr. Gary Dockery? He is a podiatrist in the Seattle area and has written extensively on denatured alcohol injections.
Marc Mitnick DPM

Comments for Baxters Nerve Entrapment

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Aug 23, 2016
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Dehydrated Alcohol USP injections
by: Arnold

As a Podiatrist, I have been using Dehydrated Alcohol USP, 1.5 cc's in 50 cc's of 2% Lidocaine for the past 10+ years. We have had a 90% success before any surgical intervention undertaken.

This sensory nerve becomes entrapped or injured by abnormal weight-bearing activity. Surgery is indicated if this procedure fails to relieve patient's heel pain. We have found that no more than three injections are necessary for the patient to relate being free of heel pain.

Arnold J. Wolf, DPM, FACFAS

Nov 17, 2012
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Definately get the alcohol injections!
by: Anonymous

I had two surgeries on one foot because of plantar fasciitis. Neither helped. They suggested cortisone, but I told them that NEVER works for me. So my dr told me about the alcohol injections, one every other week for up to 7 weeks into the baxters nerve. They worked wonderfully! I have NO foot pain at all anymore. I started having the same problem with my other foot. Had surgery, didnt work. Got the injections and now 100% better. My dr did say surgery works for most people and sometimes the extra kick of the alcohol injections will help finish the pain off. I am so glad to be able to walk and take my kids to the parks and on vacation and do things I couldn't do before the injections!

Hi,
The bigger issue in many cases of "heel pain" is that it is not actually plantar fasciitis at all but rather a nerve entrapment. Additionally, plantar fasciitis and nerve entrapement can occur together.
A proper diagnosis needs to be made before proceeding with any treatment.
I use denatured alcohol injections quite a bit in the office for Baxter's neuroma and Morton's neuroma and they work very well in the majority of cases.

Marc Mitnick DPM

Nov 12, 2008
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Baxters Nerve
by: Anonymous

Hi Dr.

I have been on Lyrica and Cymbalta for almost 2 years now. They take the edge off of he pain, but if I try to scale back on them the pain comes roaring back. My doctor wants to do a Baxters Release. Do you have any thoughts on this surgery? What are the success rates? I really have tried all other options (pt, accupuncture, steroid inj, anti inflams...) I am scared to death of surgery. I am a very slim 43 year old formerly extremely active women. I really would like my life back! All of these problems started 4 years ago with a bad sprained ankle. (after the strayer technique surgery I had the nerve pain arrived). This surgery was performed to take the pressure off of the torn peroneal longus tendon (go figure?). Once again is the Baxter Release a bad idea? The NCV was normal as well as the PSSD. The right foot mimics what the left foot is doing as well!! Same exact pain!

I appreciate your input.

Thanks,

Roxanne
Rainy Seattle

Oct 20, 2008
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Baxters Nerve
by: Roxanne

Hi Dr. Mitnick,

Thanks for the name of the Dr. in Seattle who specializes in specific injection therapies. I have had past injections (the last one caused a relapse in my symptoms. It was a diagnostic injection at the sight of the most pain, I believe he directly hit the nerve for it has been painful in that location ever since). I have tried PT, accupunture,Active Release Therapy) However prior to the last diagnostic injection my symptoms were improving but the Dr. thought one last diagnostic shot was in order.
My question to you is it worth trying one last Cortisone injection? I was told it wastes away your muscle. However I do not like the idea of surgery at all. Another strange think since the last injection is I have numbness in my finger tips as well as carpel tunnel type symptoms although the ncv turned up normal.(any connection with the last injection in my foot?)

Thanks,

Roxanne
Seattle

Hi Roxanne,
I do not know how many previous cortisone injections you have had so I do not know if I can suggest an additional one. The "rule of thumb" I use is a maximum of three in a 12 month period; some doctors will do more.
I do not think your hand symptoms are related to any foot injections.
Have you tried medications such as Neurontin or Pamelor? Might be worth a try.
Marc Mitnick DPM

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ADDITIONAL REFERENCES

Mayo Clinic

Johns Hopkins Medicine

MedlinePlus

Arthritis Foundation

University of Rochester Medical Center

Harvard Health

Drugs.com

American Academy of Pediatrics

Penn State Medical Center

National Institutes of Health

Columbia University Department of Rehabilitation

ScienceDirect

Stanford Health Care

Illinois Bone and Joint Institute

Mount Sinai Hospital

Institute for Chronic Pain

University of Florida Health

American Family Physician

Cedars-Sinai

University of Maryland Medical Center

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Unknown location

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location unknown

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Seattle, WA

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location unknown

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New Jersey

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location unknown

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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!

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Colorado

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Colorado

Wonderful advice

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This is the best site for foot problem info.

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location unknown

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Canada

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location unknown

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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

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Florida

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New Jersey

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a mom

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Lenoir, NC

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Bellevue, WA

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location unknown

Baxters Nerve Entrapment

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