Immediate pain resolution in patients with Baxter neuropathy: A novel ultrasound-guided D5W hydrodissection approach for flat feet

Background. Flatfoot is a prevalent foot deformity among Asians and is often associated with nerve entrapment. Baxter neuropathy is one of the many causes of chronic heel pain and typically responds well to conservative measures. However, in some intractable cases, more aggressive treatments, such as interventional pain management, may be necessary. Ultrasound-guided nerve hydrodissection with 5% dextrose (D5W) is a novel technique that releases the Baxter nerve from surrounding fascial planes, offering a promising therapeutic option in such cases. Case report. A 33-year-old Asian male with radiologically confirmed flatfoot presented with chronic heel pain, scoring 8 out of 10 on the numeric rating scale during activity. The pain was aggravated by long-distance walking and had begun to interfere with his professional career. His PainDETECT Questionnaire score was 17 out of 35, indicating possible neuropathic pain. The patient reported complete resolution of chronic and severe heel pain shortly after undergoing ultrasound-guided hydrodissection with D5W, with sustained relief at four months post-procedure. Conclusions. Ultrasound-guided nerve hydrodissection with D5W is a safe and effective alternative treatment for patients with Baxter neuropathy associated with flatfoot, particularly for those who cannot receive steroid-based injections. It offers both immediate and long-lasting pain relief.