Procedures Leading to Iatrogenic Injury of the Sural Nerve

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Background: Iatrogenic sural nerve injuries can result in significant patient morbidity and functional impairment following surgical procedures involving the distal leg, ankle, or lateral foot. This study investigates the surgical procedures implicated and the clinical presentation of patients with iatrogenic sural nerve injuries. Methods: The authors completed a retrospective review of 9 patients with iatrogenic sural neuropathy following surgical procedures between 2010 and 2022 at the University of Miami Health System. Patient demographics, surgical details, symptom onset, imaging findings, and final neuropathy diagnosis were extracted and analyzed. Results: The average age of patients was 47 years. The ankle was the common site of sural nerve injury (88.9%). Most patients experienced pain, numbness, and tingling, with tenderness and loss of sensation in the sural nerve distribution. The average time between surgery and completion of imaging evaluation for sural nerve injury was 80.5 weeks. All patients underwent ultrasound (77.8%) and/or magnetic resonance imaging (77.8%) evaluation postoperatively. The most frequent resulting pathology was neuroma formation, followed by entrapment, neuropraxia, and complete transection. Four patients had surgical management of sural nerve neuropathy, with none experiencing complete resolution of symptoms after surgery. Conclusions: This study highlights the surgical procedures that can result in iatrogenic sural nerve injuries beyond Achilles tendon repair. Increased awareness of surgical causes and continued reporting of iatrogenic sural nerve injuries can contribute to improved patient outcomes in procedures involving the distal lower extremity.

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