The sural nerve is formed by the union of medial sural cutaneous (from tibial nerve) and lateral sural cutaneous (from common peroneal nerve) branches in the mid-calf. As a purely sensory nerve running subcutaneously along the lateral calf and foot, it is an easily accessible donor nerve for sural nerve grafting in peripheral nerve reconstruction. Its lateral ankle position makes it vulnerable during lateral ankle surgery and calcaneal fracture fixation.
| Origin | Tibial nerve and common peroneal nerve contributions joining in the mid-calf |
|---|---|
| Course | Forms in the posterior calf from the medial sural cutaneous nerve and the fibular communicating branch, descends along the lateral border of the Achilles tendon with the small saphenous vein, passes behind and below the lateral malleolus giving lateral calcaneal branches, and continues along the lateral foot to the little toe as the lateral dorsal cutaneous nerve |
| Motor |
|
| Sensory |
|
The sural nerve is at risk in lateral ankle and hindfoot surgery, including fibular fixation, peroneal tendon repair, lateral ligament reconstruction, calcaneal fracture fixation and Achilles tendon procedures. Injury causes lateral foot numbness, usually mild, but sometimes a painful neuroma that needs excision and burying of the nerve end. It can also be compressed behind the lateral malleolus after ankle sprain or by scar. It is the most commonly used donor nerve for grafting because it is accessible, expendable and gives 30 to 40 centimetres of graft, and it is blocked behind the lateral malleolus in ankle blocks for foot surgery.
Iatrogenic division during lateral ankle, Achilles or calcaneal surgery causes lateral foot numbness, usually well tolerated but occasionally complicated by a painful neuroma.
Compression behind the lateral malleolus by scar, fracture callus or after ankle sprain causes burning lateral foot pain and numbness toward the little toe, treated by padding, injection or surgical neurolysis.
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