The sural nerve runs down through the center of the calf muscle and is one of five nerves that provide sensation to the foot.
It travels down the back of the leg, over the Achilles tendon, and then along the outside of the foot to the end of the little toe.
Comparatively, it is a fairly minor nerve, since it only provides sensation on the outside of the foot and areas between the 4th and 5th toes.
Sural Nerve Pain Causes
While the nerve may be minor in scope, it is capable of creating a fair amount of pain and discomfort when it is irritated.
Though anyone can develop this condition, it is often related to surgery in the area. When it isn’t caused by surgery, it will often be athletes who will develop it, since they regularly put stress on the area.
Luckily, they are also on the look-out for foot related nerve conditions and see doctors familiar with athletic issues on a regular basis.
Because the nerve is just under the skin, it is particularly susceptible to compression from tight shoes that put stress on the Achilles tendon.
The sural nerve can be compressed between the tendon and the shoe, and the pressure can then cause something called neuritis.
Sural neuritis can also be caused by something called “entrapment.” What this refers to is when the nerve becomes tangled in scar tissue which then puts pressure on the nerve and creates pulling.
This is, in fact, more serious than pressure created by a shoe. For one thing, this is a great deal more difficult to relieve.
For another, the scar tissue involved is often the result of surgery in the area, so the sural neuritis can actually be conceived of as a negative side effect of surgery.
There are several likely surgical culprits that might cause sural neuritis. The most common are Achilles tendon lengthening surgery, Achilles tendon surgical repair after a torn tendon, ankle fracture surgery for a broken ankle, flatfoot surgery, and fifth metatarsal fracture surgery.
This list isn’t exhaustive, but it’s reasonably well known that neuritis is a risk when these surgeries are conducted.
Sural Nerve Pain Symptoms
The symptoms of sural nerve entrapment are fairly straight-forward. Generally, the symptoms are the pain, and/or a numb or tingling feeling on the outside of the foot.
This will only rarely have an effect on your gait, but it can definitely cause a great deal of discomfort.
Unfortunately, this can develop over time, and so people may not feel motivated to get this treated right away.
In addition, this may present in combination with other pain from foot exertions, so people may just see this as a standard part of the achiness that comes with being on your feet too much.
Sural Nerve Pain Diagnosis
Because this is such a specific kind of irritation in such a small area, the diagnosis of this condition is not necessarily that difficult.
That said, there still isn’t a positive test for neuritis, and your doctor will need to engage in a process of elimination.
What that means is that they will investigate your symptoms and then use tests to rule out other causes.
Also, because of the nerve’s location, problems with the sural nerve may easily be confused with Achilles tendon issues instead.
Especially confusing is that sural neuritis can often present as Achilles tendinitis. However, this is more to do with pronation or supination of the ankle, rather than nerve issues. So, at least, there are physical symptoms that one might be able to observe.
One of the tests that are done, is called the Tinel’s test. What this involves is percussion at the site of the nerve, in this case, the ankle.
If the percussion results in tingling, pins, and needles or electric shock sensations in the area, then the test is positive. A positive test is a sign of neuritis.
More technical measures might include radiography. This will rule out problems with the bones in the area. It may pick up evidence of arthritis or stress fractures that are causing you pain, and are more serious conditions.
It might be required for you to get a magnetic resonance imaging test as well. These will be used to eliminate the soft tissues in the area as the source of your issues.
Finally, your doctor may also decide to use diagnostic nerve blocks in the area. The nerve block will do just that, blocking sensations of pain and discomfort from being transmitted to the brain.
The nerve is anesthetized and then the remaining pain is assessed. If your pain is ultimately relieved by putting the sural nerve to sleep, there is a very good chance that the sural nerve is the source of your problems.
Sural Nerve Surgery
Surgery is the final option when the sural nerve has an injury. A nerve injury can result in loss of sensation, for some, it can result in pain.
There are various types of nerve injuries, and each determines the kind of treatment to receive.
Injury of sural nerves is due to direct trauma, MCL injuries or bursitis. At times the injury can result from surgery done to treat varicose vein or hamstring graft.
The pain in the knee is called saphenous entrapment. It mainly occurs after working the quadriceps.
Injury of the sural nerve is at the superficial portion close to the skin. This is because it can be compressed and crushed.
Once injured, you are likely to experience a tingling pain or loss of sensation along the nerve’s location.
Uses of Sural Nerve in Surgery
A biopsy done will require a surgeon using a short saphenous vein to locate the sural nerve.
He then will cut an inch length of the nerve, close the wound and wrap it in a gauze that contains saline.
The sample nerve will guide the doctor to know if there are any nerve disorders.
The second way the nerve can be of use is when performing a graft. A piece of the sural nerve is removed and transplanted into the area that has damaged nerves.
The sural nerve is spliced with the existing nerve to restore sensation and functionality to the muscles.
The procedure above is mainly for restoring feeling to damaged limbs.
Transplanting a sural nerve to the pelvic area is often done by surgeons after prostate surgery. The nerve helps to restore any lost sexual function.
Sural Nerve Flossing
A technique that helps your nerves have more freedom within the soft tissues that surround the nerve.
There are specific movements that work on particular nerves located in the same position for everyone.
Purpose of Nerve Flossing
Nerve flossing pulls one end of the nerve while keeping the other relaxed. This removes any entrapments that are on it.
It stretches tissues that surround the nerve and break down any built-up fibrotic scar tissue that makes the nerve not to glide smoothly when you move your leg.
Just like you floss your teeth as often as you do to remove plaque that has build up, nerve flossing does the same to the nerve.
In the YouTube video here you will find what nerve flossing is in more detail and what moves work for the saphenous nerve.
Sural Nerve Exercises
The exercises that are done to treat sural nerve damage are delicate as you are trying to get relief, but at the same time, you aren’t trying to make the situation worse than it already is. One exercise you can do is the saphenous nerve glide.
All you have to do is stand with your back facing the wall. Using the unaffected leg, take a huge step and place the sole of the injured foot against the wall, and turn it out.
Make sure your back leg is straight, hips are facing forward and your body is up tall.
Bend the front leg and put your weight on it, as this will increase the tension on the affected nerve. Create a rhythm by bending and straightening your front leg.
To make the exercise a tad difficult, when bending your front knee, raise the arm of the injured leg up and over, simultaneously extend your head backward.
For stretching, you can do a V-sit. While you are on the floor, in a V-shape, stretch your legs out in front of you.
Keep your knees straight. Bend the right foot from your waist, making sure your chest and head are upright, and hold for a few seconds.
Return to the original position and stretch forward at your waist. This will stretch out those hamstrings, and you will feel this on your knees or thighs.
Hold for a few seconds and return to original position. Then bend to the left foot and repeat what you did on the right leg.
To work on your hip flexors, here’s an exercise you can try. With your right knee on the floor and the left knee bent, make a half-knee.
Make sure that your left bent knee is directly over the ankle or you’ll be doing this exercise wrong.
Maintain a good posture by ensuring your head is over the shoulder. Tighten your butt to make the tailbone point downward, to prevent you from arching your back. This will gently stretch your front thigh or hip.
If there’s no resistance, slide your opposite foot forward and lunge forward slowly so that the knee lines up with your ankle.
Ensure your back isn’t arching. Hold this position for several seconds, not too long to the point of feeling pain.
Sural Nerve Surgery Recovery Time
Recovery time depends on the level of your injury. Those with a level four nerve injury, which involves a nerve graft, repair or transfer are bound to make a full recovery at a slower rate, with an inch a month.
A fifth level injury that requires the same surgery will take the same time as a level four injury to recover.
Sural Nerve Massage
Direct massage to the affected area, such as your knee or ankle will help ease the pain.
Make sure you aren’t pressing down too hard to make it unbearably painful. This way you are breaking up the scar tissue to help the nerve get accustomed to being moved.
If there’s too much pain in your ankle, you can soak your ankle for ten to fifteen minutes in warm water three times a day. Then follow up with a gentle massage to calm the nerve down.
Here a YouTube Video you are going to find a massage that will work on your knee if you are in pain.
Remember, do the massage gently and you’ll relieve any pain you might feel on your knee.
Sural Nerve Pain Treatment
Treatment can involve self-care measures, medication and also more radical measures, like surgery, might be required.
Like a regular type of injury, the sural nerve will respond to cold temperatures. The first thing to do is to apply ice to the area to ease irritation and inflammation of the nerve.
Make sure your shoes aren’t responsible for the compression. If your footwear has straps or seams that press on the Achilles tendon, then it’s time to replace them.
You can also start taking non-steroidal anti-inflammatory drugs like ibuprofen. These drugs are not only pain relievers, they also act to reduce inflammation, which will relieve both the irritation and pressure on your sural nerve.
Your doctor may also decide that steroid injection as well. These are done to relieve inflammation, so it will relieve the stress on the nerve.
Finally, if there are no other options left, then it is possible that surgery may be used to release the nerve from entrapment. As in most conditions, surgery is a last resort, undertaken when there don’t seem to be other measures that will be helpful.
“Tinel’s Test.” eHealthstar. http://www.ehealthstar.com/test/tinels-test.
“Sural Neuritis.” Ankle and Foot Center: San Francisco Bay Area Foot Pain Information Site. http://www.anklecenter.com/index.php?option=com_content&view=article&id=143:sural-neuritis&catid=118:outside-foot-pain&Itemid=188.
“Sural Neuritis.” Complete Foot & Ankle Care, Indiana Podiatry Group. http://www.inpodiatrygroup.com/sural-neuritis.html.