Sural Nerve Injury
- 1 Other Names
- 2 Background
- 3 Pathophysiology
- 4 Risk Factors
- 5 Differential Diagnosis
- 6 Clinical Features
- 7 Evaluation
- 8 Classification
- 9 Management
- 10 Rehab and Return to Play
- 11 Complications and Prognosis
- 12 See Also
- 13 References
- Sural Neuropraxia
- Sural Mononeuropathy
- This page refers injuries to the Sural Nerve
- Poorly described in the literature
- Sensory nerve of the posterolateral calf and ankle, lateral foot
- No motor component
- Entrapment site
- Most cases in literature involve entrapment at the ankle
- Can occur as proximal as popliteal fossa
- As distal as base of fifth metatarsal
- Entrapment neuropathy
- At the crural fascia
- Mass lesions at the level of the gastrocnemius aponeurosis
- Scar Tissue
- External Compression
- Ski Boots
- Heel straps
- Tightly laced boots
- Surgical repair of Achilles Tendon Rupture
- Ranges from 1.7% to 23% after percutaneous repair
- As high as 60% when considering all surgical approaches
- Surgical repair of Calcaneus Fracture
- Ranges from 5% to 8%
- More proximal neuropathies including
- Case reports following
- Sural Nerve
- Fractures & Dislocations
- Muscle and Tendon Injuries
- Nerve Injuries
- Pediatric Considerations
- Patient will report paresthesia on the posterolateral side of leg and foot
- They may also endorse burning pain
- Physical Exam
- Point of maximal tenderness can potentially reproduce symptoms
- Sensory deficits: posterolateral side of the lower leg, lateral border of the foot, small area under the heel
- Motor exam should be normal
- Special Tests
- Can be used to confirm diagnosis
- Not applicable
- Most cases
- Treat underlying etiology (i.e. bakers cyst, calf strain)
- Discontinue offending activity
- Remove space occupying lesions
- Fascia related compression
Rehab and Return to Play
Return to Play/ Work
Complications and Prognosis
- Chronic neuropathic pain
- Chronic paresthesia
- Husson, J. L., J. M. Blouet, and A. Masse. "Le syndrome du défilé de l'aponévrose superficielle postérieure surale." International orthopaedics 11.3 (1987): 245-248.
- Reisin R, Pardal A, Ruggieri V, Gold L. Sural neuropathy due to external pressure: report of three cases. Neurology 1994;44: 2408-9.
- Perlman, M. D. "Os peroneum fracture with sural nerve entrapment neuritis." The Journal of foot surgery 29.2 (1990): 119-121.
- Blackmon, Joseph A., et al. "Locating the sural nerve during calcaneal (Achilles) tendon repair with confidence: a cadaveric study with clinical applications." The Journal of Foot and Ankle Surgery 52.1 (2013): 42-47.
- Haugsdal, Jaclyn, Jeremiah Dawson, and Phinit Phisitkul. "Nerve injury and pain after operative repair of calcaneal fractures: a literature review." The Iowa orthopaedic journal 33 (2013): 202.
- Jotwani, Vijay, Kathleen Weber, and Simon Lee. "Cutaneous sural nerve injury after lateral ankle sprain: a case report: conducting a thorough neurological examination is a key to evaluation." The Journal of Musculoskeletal Medicine 25.3 (2008): 126-126.
- Bryan III, Blackshear M., Gregory E. Lutz, and Stephen J. O'Brien. "Sural nerve entrapment after injury to the gastrocnemius: a case report." Archives of physical medicine and rehabilitation 80.5 (1999): 604-606.
- Nakano KK. Entrapment neuropathy from Baker’s cyst. JAMA 1978;239:135.
- Schottland JR. Sural neuropathy. Neurology 1995;45:2301.
- Moore KL, Dalley AF, Agur AMR. Clinically Oriented Anatomy, ed 6, Lippincott Williams & Wilkins, Baltimore, 2010. p 619