Morphological Variability of the Sural Nerve and Its Clinical Significance

Abstract

The sural nerve provides sensory innervation to the skin on the distal posterolateral third of the lower extremity. The morphological variants are characterized by high variability. However, it most commonly arises from a union of the medial sural cutaneous nerve and the peroneal communicating branch of the common fibular nerve. This article overviews the anatomical and clinical significance of the sural nerve. Despite the remarkable development of genetic diagnostics, sural nerve biopsy is still a very important tool to diagnose peripheral neuropathies such as diabetic, vascular and inflammatory neuropathies. Furthermore, the sural nerve is also commonly transplanted due to its characteristics. Such a procedure is applicable in cases of segmental nerve loss, but it is also used to restore potency in patients after radical prostatectomy. The knowledge of anatomical variants of the sural nerve is also crucial as it allows to minimize its damage during surgical procedures. Furthermore, during an ankle surgery, a nerve block can be used to complement anesthesia. The major aim of this work is to review contributions of the sural nerve to physiological and pathophysiological processes.

Keywords: anatomical variations; peripheral neuropathy; sural biopsy; sural mononeuropathy; sural nerve; sural nerve entrapment; sural nerve graft.

Figure 1

(a) The small saphenous vein and the sural nerve; Henry Vandyke Carter, public domain, via Wikimedia Commons [17]; and (b) the most common formation of the sural nerve; Robert Steele MS DO, via Wikimedia Commons [18].