Nerve Compression of the Sural Nerve
Nerves may be compressed from tight ligaments, inflamed tendons, tumors, fracture fragments, varicose veins, scar tissue or injuries to the foot that cause the foot and ankle to be misshapen (severe flatfoot). Nerve compression may cause significant discomfort with weight-bearing. Night pain and pain while the patient is nonweightbearing are common as well. The most important thing a physician can do is to direct the treatment to the cause of the problem. If the foot is misshapen causing no pain (numbness, tingling or shooting), the nerve does not need surgery, the foot and ankle bones might. The wrong diagnosis can be disastrous. If a tumor or varicose vein is causing the pain they may need to be resected to allow the nerve to function normally. Anything abnormally applying pressure to the nerve may cause symptoms. If a tight ligament is identified, it has to be released to allow the nerve to function normally. Occasionally nerve conduction studies are performed to assess the degree of nerve compression and nerve damage
The sural nerve (short saphenous nerve), formed by the junction of the medial sural cutaneous with the peroneal branch of the lateral sural cutaneous nerve, passes downward near the lateral margin of the Achilles tendon, lying close to the small saphenous vein, to the interval between the lateral malleolus and the calcaneus. It runs forward below the lateral malleolus and is continued as the lateral dorsal cutaneous nerve along the lateral side of the foot and little toe (via a dorsal digital nerve), communicating on the dorsum of the foot with the intermediate dorsal cutaneous nerve, a branch of the superficial peroneal nerve. In the leg, its branches communicate with those of the collateral branches off of the common tibial, and common fibular nerve.
Damage to this nerve, due to its purely sensory function, will leave numbness or tingling at and distal to the area of compression.
Intraop Pics of the Sural nerve that was entrapped. We released the nerve and attached the stump of the nerve into the peroneal muscle with suture
Intraop Pics of Sural Neurectomy for Sural Neuralgia