It really has been over 6 months of pain. You know, pain that comes and goes -not so crippling that I can’t work out or run. Just enough that when I wake up I have to tip toe out of bed the first 20 min then it’s like already 75% better. - Until I sit for a while and then have to get back up and it starts back over.

BUT I do NOT have pain in the foot along the arch. It is ONLY in my heel bone tissue and around my calceneus.

As a PT - I always to back to MOI - Mechanism of Injury - of which NOW i can’t remember. I do remember how it got worse. However, recently I walked 2 miles in Chacos up/down a hill at a camp with my daughters youth group in April. Then I played ultimate frisbee for almost 2 hours with a group literally less than half my age in bad Brooks. That’s when it got worse. Then, I stood for 10+ hours at the Elevate HER Women’s Event in a different pair of Saucony’s I gave away because it seemed to exacerbate my pain. All of which are things I have not done in a very long time.

What did I do?

It did get better. I had my friend Christian of Soul Arrow Acupuncture target it in my last session with her which much to my suprise is what did make it better. But she did not even needle it- she needled my thumb!! I also used my shockwave device, mobilize my own heel bone, massaged the big toe abductor, tried to needle myself, nerve glides, calf stretches, strengthening of the bottom muscles of my feet - Then, I played baseball in the front yard and it got worse after pushing off of it to try to catch a ball in flipflops.

I did a little more research and reached out to another PT friend and this is what I was reminded of:

Heel Pain: What If It’s Not Plantar Fasciitis?

If you’ve been dealing with persistent heel pain and the usual plantar fasciitis treatments aren’t working, it might be time to consider a less commonly diagnosed culprit: Baxter’s nerve entrapment.

🔍 What Is Baxter’s Nerve?

Baxter’s nerve is the first branch of the lateral plantar nerve, which itself branches off from the tibial nerve. It runs along the inside of the heel and passes between tight anatomical structures in the foot—making it prone to getting compressed or entrapped, especially in people with flat feet, overpronation, or chronic foot tension.

⚠️ Why It’s Often Missed

Most people with heel pain get labeled with “plantar fasciitis,” especially when pain is felt at the bottom of the heel. But not all heel pain stems from the plantar fascia.

Baxter’s neuropathy can mimic plantar fasciitis. What sets it apart is:

• Burning, tingling, or electric-type pain

• Pain that worsens throughout the day

• Pain that doesn’t respond to stretching, rolling, or orthotics

• Possible weakness in toe abduction (especially the 5th toe)

In contrast, plantar fasciitis typically:

• Hurts most with the first step in the morning

• Improves as the foot warms up

• Responds to calf stretching, arch support, and tissue work

• Visible injury to tendon on Ultrasound or imaging

🧠 What the Research Says

Several recent case studies and reviews emphasize that Baxter’s nerve entrapment is underdiagnosed. One 2020 case report highlighted how ultrasound-guided hydrodissection of Baxter’s nerve helped a patient with chronic heel pain who was previously misdiagnosed with plantar fasciitis (Sahoo et al., 2020).

Similarly, a 2023 review in Arch Clin Exp Orthop discussed how this small nerve can be a major source of pain—and how releasing it led to significant relief for patients who had suffered for years.

StatPearls, a respected clinical resource, emphasizes that diagnosing nerve entrapment requires deeper clinical evaluation, especially in cases unresponsive to standard care.

Dry needling can be effective in releasing tension along plantar surface of the foot as reported in a Meta-Analysis in 2021. Dry needling with electrical stimulation has been shown to reduce pain in the morning, at rest, and eliminated medication usage more quickly than other treatments. (https://pubmed.ncbi.nlm.nih.gov/30379937/)

👣 How This Shows Up in Our Clinic

At Priority Physical Therapy, we’re trained to think beyond basic labels. When we see a patient whose heel pain isn’t improving, we assess for nerve involvement, movement patterns, muscle tension, and even pelvic positioning, since the entire kinetic chain plays a role.

This isn’t about guessing — it’s about being curious clinicians who dig deeper.

🙌 You Don’t Have to “Live With It”

If your heel pain isn’t responding to the typical plantar fasciitis playbook, you deserve a thorough evaluation that looks at the full picture—including nerve health.

Pain doesn’t mean you’re broken. But it is a message. Let’s decode it together.

Heel pain - Plantar Fasciitis or Nerve Entrapment?