Sural is the Latin term for the calf of the leg. There are numerous reports of injury to sural and peronial nerves on one leg causing disability to the opposite leg. The sural nerve is joined by fibers from the common peroneal nerve and runs down the calf to supply the lateral side of the foot.
Sural neuropathy: The sural nerve can be injured at the ankle by tendon sheaths and scar tissue. Sural nerve entrapment localized to its course as it passes through the superficial sural aponeurosis is described in athletes. Such entrapment results in chronic calf pain, exacerbated by physical exertion.
Tibial nerve syndromes involve the tibial nerve, which branches from the sciatic nerve, descends through the popliteal fossa, and passes deep between the heads of the gastrocnemius muscle, which it supplies. The nerve becomes superficial along the medial aspect of the ankle and passes under the flexor retinaculum into the foot. The flexor retinaculum forms the roof of the tarsal tunnel.
The medial sural cutaneous nerve originates from the tibial nerve of the sciatic, descends between the two heads of the Gastrocnemius, and, about the middle of the back of the leg, pierces the deep fascia, and unites with the anastomotic ramus of the common peroneal to form the sural nerve.
The lateral sural cutaneous nerve originates from the Common fibular nerve. One branch, the peroneal anastomotic (n. communicans fibularis), arises near the head of the fibula, crosses the lateral head of the Gastrocnemius to the middle of the leg, and joins with the medial sural cutaneous nerve to form the sural nerve.
Principles and Practice of Pain Medicine By Carol A. Warfield, Zahid H. Bajwa, page 324: sural neuropathy - calf pain, illustration:
Common peroneal nerve (anterolateral aspect of the right leg) Schematic representation of its course, clinically relevant anatomic relations, and major branches. (from Peripheral Neuropathy, Saunders: 1984
Anomalous Course of the Medial Sural Cutaneous Nerve and Its Clinical Implications by Maria Lúcia Pimentel, Rodrigo Mota Pacheco Fernandes and Márcio Antônio Babinski - Department of Morphology, Biomedical Institute, Fluminense Federal University, Niterói, RJ, Brazil. ABSTRACT: The sural nerve is formed by the union of the medial sural cutaneous nerve, which is a branch of the main trunk (the tibial nerve), and the common fibular communicating branch of the lateral sural cutaneous nerve, which is a branch of the common fibular nerve. Anatomical variations in the formation of the sural nerve are common, although the topographical localization of this nerve is constant.
Conservative Treatment of Bilateral Sural
Nerve Entrapment- in an Ice Hockey Player by Brian J. Toy, PhD, ATC, 1996.
Intraneural Injections for Rheumatoid Arthritis and Osteoarthritis by Paul K. Pybus. See last article in book: Intraneural Injections by Gus J. Prosch, Jr., M.D. Lecture #2 1987 see illustrations (Exhibits) # 14,15,16 showing injection points relative to nerves in leg.
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