Sural Nerve

Anatomy

The sciatic nerve splits into the tibial nerve and the common peroneal (fibular) nerve near the popliteal crease. 

The tibial nerve travels distally, giving rise to the medial sural nerve and posterior tibial nerve, which cover the posterior leg and plantar surface of the foot. 

The medial sural nerve runs between the gastrocnemius muscle heads, through the deep fascia to become superficial about halfway down the calf, and continues posterior to the lateral malleolus and superficial to the extensor retinaculum.

Sural Nerve Block

Sural nerve blocks are a type of regional anesthetic used as an alternative or supplement to general anesthesia for foot and ankle surgery.

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Indications

The sural nerve block provides postoperative pain relief and regional anesthesia to the posterolateral calf and dorsolateral fifth digit.

Clinical Significance

While the sural nerve innervates the posterolateral calf and dorsolateral foot, it is the least studied of the five major ankle nerves. A PubMed search using the keywords "sural nerve" and "regional anesthesia" generated only six references. 

This observation could be due to the omission of the sural nerve block in certain foot surgeries, as it only contributes a minor amount to the forefoot.

References

and Interesting Articles

  • D'Souza RS, Johnson RL. Sural Nerve Block. [Updated 2022 May 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519541/
  • HUTCHESON JB. Acute lateral ankle sprains treated by sural nerve block. U S Armed Forces Med J. 1951 May;2(5):799-801. PMID: 14836073.
  • Lawrence SJ, Botte MJ. The sural nerve in the foot and ankle: an anatomic study with clinical and surgical implications. Foot Ankle Int. 1994 Sep;15(9):490-4. doi: 10.1177/107110079401500906. PMID: 7820241.
  • Mazzella NL, McMillan AM. Contribution of the sural nerve to postural stability and cutaneous sensation of the lower limb. Foot Ankle Int. 2015 Apr;36(4):450-6. doi: 10.1177/1071100714560398. Epub 2014 Dec 19. PMID: 25527006.

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