Anatomy of the Sural Nerve Related to Calcaneal Tendon, Intermalleolar Line and Small Saphenous Vein

Abstract

DANGINTAWAT, P.; HUANMANOP, T.; AGTHONG, S. & CHENTANEZ, V.Anatomy of the sural nerve related to calcaneal tendon, intermalleolar line and small saphenous vein. Int. J. Morphol., 34(1):380-384, 2016. SUMMARY:Sural nerve (SN) courses from the posterior aspect of leg to the lateral side of ankle and foot. Anatomy of the SN is of clinical importance due to its involvement in nerve biopsy, nerve graft harvesting including injuries during calcaneal tendon repair. Despite substantial knowledge in the literature, more easily located landmarks and data regarding the symmetry are still needed. Ninetyeight lower extremities from 31 males and 18 females were dissected in this study. The SN originated from the union between the medial and lateral sural cutaneous nerves in 52.0 % of the legs. The distance from the union point to the intermalleolar line (IML) was 16.3±8.4 (SD) cm. The ratio of this distance to the fibular length (apex of head to lateral malleolus or LM) was 0.47±0.23 cm. In 84.7 % of the legs, the SN initially coursed medial to and then crossed the lateral border of calcaneal tendon at the distance of 8.4±2.1 cm above the IML. The ratio to the fibular length was 0.25±0.06 cm. At the level of IML, the SN was posterior to the most prominent part of the LM in 95.9 % of the legs with the distance of 2.6±0.5 cm. At the closest point, the SN was lateral to the small saphenous vein in 74.5 % of the legs and the distance from this point to the IML was 10.6±4.7 cm. The ratio to the fibular length was 0.31±0.14 cm. Side difference or asymmetry was observed in a substantial number of specimens. These data are crucial for not only localizing the SN during biopsy and graft harvesting but also avoiding the nerve injury during relevant surgical procedures.

Anatomy of nerves of the lower extremities in the context of the treatment for varicose veins

“…Because of a high risk of sural nerve injury in this area, the distal part of the SSV should not be ablated if this part of the vein is not pathologically dilated or refluxing [7]. Typically, the most vulnerable is the middle part of the sural nerve, which is close to the SSV, although it rarely strictly adheres to the vein [9,24,[26][27][28][29]. A lower incidence of sural nerve injuries in its proximal part is associated with the fact that usually in this area the nerve is not situated inside the interfascial compartment but is separated from the SSV by the muscular fascia.…”

Etiology and Treatment Outcomes for Sural Neuroma

“…Near the foot and ankle, this nerve lies in close proximity to the lateral aspect of both the Achilles and peroneal tendons, putting it at risk for injury. 7,24 Few prior studies have focused on sural neuromas, in part because this nerve has been considered expendable given its common use as a source of nerve autograft. 18 Development of a painful neuroma, however, has the potential for reducing one's quality of life, and sural neuromas are no exception.…”