The sural nerve in the foot and ankle: an anatomic study with clinical and surgical implications

Operative procedures and traumatic injuries of the lateral foot and ankle place the sural nerve and its branches at risk. Anatomic studies quantifying the course of this nerve are sparse. In this study, 17 cadaver specimens were dissected to clarify its course and branching patterns. Despite multiple variations of the nerve and its branches, description of the course of a "typical" nerve trunk was possible. The nerve was found to lie in close proximity to the Achilles tendon at a level of 7 cm above the tip of the lateral malleolus. In the hindfoot, the nerve coursed 14 mm posterior and 14 mm inferior to the malleolus. Distally, it crossed superficial to the peroneus longus and brevis tendons. An anastomotic branch coursing into the sinus tarsi area was observed in 24% of specimens. An understanding of the course and distribution of the sural nerve may lessen the risk of iatrogenic injury.