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What is the Sural Nerve?
The Sural nerve is a cutaneous nerve which is a type of nerve that supplies sensation to the skin. As a sensory nerve, the Sural Nerve can detect foot position, temperature, pain, vibration and touch. The sural nerve provides sensation to the lower 1/3 of the outer leg, outer heel and the outer aspect of the foot.
Sural Nerve Pain
As the Sural Nerve is a superficial nerve, it can be easily irritated from entrapment, ankle sprains, muscular tightness, and being overstretched. When the sural nerve becomes inflamed, it is referred to as Sural Neuritis, which often results in a burning pain in the lateral shin or the lateral foot (foot sural nerve pain). Patients often describe their pain as constant pain that can be made worse with activity but remains present at rest. Sitting for long periods or driving can often exacerbate the symptoms of sural nerve pain as it places the nerve under tension.
Sural Nerve Pain is commonly misdiagnosed as the following conditions:
Causes of Sural Nerve Pain
One of the most common causes of Sural Nerve Pain is a sprained ankle where the foot inverts at speed, stretching the Sural Nerve and causing it to become inflamed and painful. Tight shoes or ill-fitting ski boots can directly compress the Sural Nerve leading to a Sural Nerve Entrapment or thickening of muscular tissue or fascia around the Sural nerve can irritate it.
Other causes of Sural Nerve Pain include irritation from metalwork after orthopaedic surgery or diabetes-related neuropathy.
Diagnosis of Sural Nerve Pain
Sural Nerve Pain is usually diagnosed in a clinic by a Physical Therapist using a combination of clinical tests sural as a sural nerve tension test which is a modified version of a straight leg raise test. Tapping (Tinel’s test) of the nerve can elicit the patient’s symptoms while it may be tender to palpate along the anatomical pathway of the Sural Nerve.
In most cases, it is challenging to identify Sural Nerve pain on a scan. There may be some signs of inflammation on an MRI scan, but in most cases, an MRI will return as ‘normal’. In these instances, the results of a Physical examination alongside a thorough subjective interview are sufficient to establish the diagnosis.
Sural Nerve Pain: Treatment
Treatment for Sural Nerve Pain is typical with Physical Therapy involving mobilisation of the ankle joint, foot and fibula. Soft tissue release may be used on the surrounding tissues of the Sural nerve, such as the calf muscle, peroneal muscles and proximally on the lateral hamstring muscles. Advice on footwear and in some cases insoles can be helpful.
Exercises to relieve Sural Nerve pain include the Sural Nerve Glider and gentle stretching of the calf, hamstring and gluteal muscles.
To perform the sural nerve glider:
- Lie on your back and bring your knee up to 90º of hip flexion.
- Hug the back of your thigh with both hands to hold your leg in position
- Straighten your knee as much as possible without moving your thigh
- Hold this position and gentle pump your foot up and down
- Repeat 12 repetitions, 3-4 times daily
In most cases, manual therapy combined with the appropriate rehabilitation exercises is sufficient to relieve Sural Nerve Pain. In rare instances, a steroid injection may be required to reduce inflammation within the nerve and a period od 1-2 weeks in a walker boot may be recommended to allow the injection to take maximum effect.
Physiotherapy with James McCormack
This is not medical advice. We recommend a consultation with a medical professional such as James McCormack. He offers Online Physiotherapy Appointments for £45.
Related Article: Causes of outer ankle pain