Clinical Presentations
The sural nerve runs down the back of the leg, behind the outside edge (lateral) of the ankle, and along the outside of the foot. The nerve provides sensation to all those areas and the 4th and 5th toes. The nerve can develop neuritis as a result of an injury, irritation, or inflammation. Sural Neuritis leads to pain on the outside of the hindfoot that is often burning in nature. Symptoms can be aggravated by direct pressure. The involved area is often hypersensitive to touch. A stretching injury to the nerve, such as that which may occur in an ankle sprain, is a common cause of sural neuritis. This commonly resolves with time. During surgery, the course of this nerve is variable, and therefore although uncommon it may be injured during standard surgical approaches. Retractors used to aid in the exposure of the surgical incision may inadvertently stretch the nerve, and bleeding and bruising following surgery may cause excessive scarring around the nerve. Sometimes, simply the swelling for surgery or injury in the area disturbs the function of the nerve, and symptoms can develop. Any of these mechanisms can lead to the development of sural neuritis with resulting pain and/or irritation at the site of injury, and with altered sensation or numbness from that location down the remaining course of the nerve.