The sural nerve is formed by the union of the two sural contributions, running lateral to the Achilles tendon behind the lateral malleolus to supply the lateral foot and little toe. It is the most commonly harvested nerve for cable nerve grafting in peripheral nerve reconstruction — the sural provides 20-30 cm of accessible autograft with only lateral foot numbness as the donor deficit. It is at risk during lateral ankle surgery, Achilles tendon repair, and peroneal tendon procedures.
| Origin | Formed by the union of the medial sural cutaneous nerve (from tibial) and the lateral sural cutaneous nerve (from common peroneal) in the midcalf |
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Sural nerve injury during Achilles tendon surgery or posterior ankle arthroscopy produces lateral foot numbness and occasionally painful neuroma. The nerve is identified and protected in all posterolateral ankle and Achilles approaches. Sural nerve cable grafts are used in facial nerve, median nerve, and brachial plexus reconstruction.
Lateral foot numbness from sural nerve damage during posterolateral ankle approach managed with observation and neuroma treatment for symptomatic cases.
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