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Heel pain is a common clinical symptom.
Heel pain is a common clinical symptom.
Anatomy: Anatomy:
The two terminal branches of the tibial nerve are the medial plantar nerve and the lateral plantar nerve.
The two terminal branches of the tibial nerve are the medial plantar nerve and the lateral plantar nerve.
Baxter's nerve (Baxter nerve) is the first branch of the lateral plantar nerve, also known as the inferior calcaneus nerve, which innervates the abductor digitorum muscle (AbDM)
Lateral plantar nerve: Lateral plantar nerve (LPN)
Lateral plantar nerve: Lateral plantar nerve (LPN)
Medial plantar nerve: Medial plantar nerve (MPN) Medial plantar nerve (MPN)
Abductor digiti minimi: Abductor digiti minimi (AbDM)
Abductor minor digiti: Abductor digiti minimi (AbDM) Abductor minor digiti: Abductor digiti minimi (AbDM)
pathology:
Pathology: Pathology:Baxter nerve entrapment is common in two places (see picture below)
Baxter nerve entrapment is common in two places (see picture below)
Baxter nerve entraps two potential sites (in the oval circle):
Two potential parts of Baxter nerve compression (in the oval circle): Two potential parts of Baxter nerve compression (in the oval circle):1.
1.
2.
Imaging performance:
Imaging performance: Imaging performance:
Acute and subacute muscle denervation are best assessed by fluid-sensitive sequences, such as T2WI images with fat suppression (T2 FS) or short tau reversal recovery (STIR) images.
Compared with normal muscles, the muscle abdominal The increased signal is related to neurogenic muscle edema.
The enhanced scan occurs in the acute to subacute stage of denervation; in the case of Baxter nerve compression, according to the patient’s innervation anatomy, muscle edema will be selectively in the abductor digitorum (AbDM) occurs internally, and may also occur in the flexor digitorum brevis and quadratus plantar muscle; obvious muscle atrophy and fatification can be seen in the chronic phase
.
Acute and subacute muscle denervation are best assessed by fluid-sensitive sequences, such as T2WI images with fat suppression (T2 FS) or short tau reversal recovery (STIR) images.
Compared with normal muscles, the muscle abdominal The increased signal is related to neurogenic muscle edema.
The enhanced scan occurs in the acute to subacute stage of denervation; in the case of Baxter nerve compression, according to the patient’s innervation anatomy, muscle edema will be selectively in the abductor digitorum (AbDM) occurs internally, and may also occur in the flexor digitorum brevis and quadratus plantar muscle; obvious muscle atrophy and fatification can be seen in the chronic phase
.
T1 image muscle showed isosignal (asterisk) and no atrophy; suppressed T2 image showed muscle edema of the abductor digitorum (arrow) and flexor digitorum brevis (arrow)
.
.
T1 image muscle showed isosignal (asterisk) and no atrophy; suppressed T2 image showed muscle edema of the abductor digitorum (arrow) and flexor digitorum brevis (arrow)
.
Coronal abductor of the little toe of a patient suffering from severe atrophy and fatty infiltration of T1WI and suppression PDWI image, due to chronic Baxter nerve involvement selectively involving the abductor of the little toe; signal strength of the abductor of the little toe (arrow) with similar There is no obvious muscle edema in adjacent subcutaneous fat
.
Coronal abductor of the little toe of a patient suffering from severe atrophy and fatty infiltration of T1WI and suppression PDWI image, due to chronic Baxter nerve involvement selectively involving the abductor of the little toe; signal strength of the abductor of the little toe (arrow) with similar There is no obvious muscle edema in adjacent subcutaneous fat
.
Coronal abductor of the little toe of a patient suffering from severe atrophy and fatty infiltration of T1WI and suppression PDWI image, due to chronic Baxter nerve involvement selectively involving the abductor of the little toe; signal strength of the abductor of the little toe (arrow) with similar There is no obvious muscle edema in adjacent subcutaneous fat .
The transverse T1WI and coronary fat suppression PDWI images of another patient with chronic Baxter nerve compression showed severe diffuse atrophy and fatty infiltration of the abductor digitorum (arrow) .
The transverse T1WI and coronary fat suppression PDWI images of another patient with chronic Baxter nerve compression showed severe diffuse atrophy and fatty infiltration of the abductor digitorum (arrow) .
The transverse T1WI and coronary fat suppression PDWI images of another patient with chronic Baxter nerve compression showed severe diffuse atrophy and fatty infiltration of the abductor digitorum (arrow) .
The initial treatment of Baxter nerve compression is usually conservative treatment, including a combination of rest, non-steroidal anti-inflammatory drugs, corticosteroid injections, and orthotics
.
If persistent pain persists after conservative treatment, surgery can be performed
.
The initial treatment of Baxter nerve compression is usually conservative treatment, including a combination of rest, non-steroidal anti-inflammatory drugs, corticosteroid injections, and orthotics
.
If persistent pain persists after conservative treatment, surgery can be performed
.
in conclusion:
Conclusion: Conclusion:
Baxter nerve compression is a clinically difficult diagnosis and is often overlooked in the manifestations of heel pain
.
MRI can evaluate the denervation effect of nerve compression by identifying abnormalities in the abdomen of the abductor digitorum (AbDM) muscle
.
In addition, potential causes of impact (eg calcaneal spurs, soft tissue masses, vasodilatation) and related pathologies (eg plantar fasciitis, tendinopathy) can be found, and other differential diagnoses (eg stress fractures) can be ruled out
.
Baxter nerve compression is a clinically difficult diagnosis and is often overlooked in the manifestations of heel pain
.
MRI can evaluate the denervation effect of nerve compression by identifying abnormalities in the abdomen of the abductor digitorum (AbDM) muscle
.
In addition, potential causes of impact (eg calcaneal spurs, soft tissue masses, vasodilatation) and related pathologies (eg plantar fasciitis, tendinopathy) can be found, and other differential diagnoses (eg stress fractures) can be ruled out
.
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