{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T23:22:32Z","timestamp":1778109752066,"version":"3.51.4"},"reference-count":62,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2024,10,11]],"date-time":"2024-10-11T00:00:00Z","timestamp":1728604800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>The sural nerve provides sensory innervation to the skin on the distal posterolateral third of the lower extremity. The morphological variants are characterized by high variability. However, it most commonly arises from a union of the medial sural cutaneous nerve and the peroneal communicating branch of the common fibular nerve. This article overviews the anatomical and clinical significance of the sural nerve. Despite the remarkable development of genetic diagnostics, sural nerve biopsy is still a very important tool to diagnose peripheral neuropathies such as diabetic, vascular and inflammatory neuropathies. Furthermore, the sural nerve is also commonly transplanted due to its characteristics. Such a procedure is applicable in cases of segmental nerve loss, but it is also used to restore potency in patients after radical prostatectomy. The knowledge of anatomical variants of the sural nerve is also crucial as it allows to minimize its damage during surgical procedures. Furthermore, during an ankle surgery, a nerve block can be used to complement anesthesia. The major aim of this work is to review contributions of the sural nerve to physiological and pathophysiological processes.<\/jats:p>","DOI":"10.3390\/jcm13206055","type":"journal-article","created":{"date-parts":[[2024,10,11]],"date-time":"2024-10-11T08:10:16Z","timestamp":1728634216000},"page":"6055","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Morphological Variability of the Sural Nerve and Its Clinical Significance"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7427-6809","authenticated-orcid":false,"given":"Weronika","family":"Marcinkowska","sequence":"first","affiliation":[{"name":"Department of Anatomical Dissection and Donation, Medical University of Lodz, 90-419 \u0141\u00f3d\u017a, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9851-7769","authenticated-orcid":false,"given":"Nicol","family":"Zielinska","sequence":"additional","affiliation":[{"name":"Department of Clinical Anatomy, Masovian Academy in P\u0142ock, 09-402 P\u0142ock, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bart\u0142omiej","family":"Szewczyk","sequence":"additional","affiliation":[{"name":"Department of Clinical Anatomy, Masovian Academy in P\u0142ock, 09-402 P\u0142ock, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Piotr","family":"\u0141ab\u0119towicz","sequence":"additional","affiliation":[{"name":"Department of Clinical Anatomy, Masovian Academy in P\u0142ock, 09-402 P\u0142ock, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5734-116X","authenticated-orcid":false,"given":"Mariola","family":"G\u0142owacka","sequence":"additional","affiliation":[{"name":"Nursing Department, Masovian Academy in P\u0142ock, 09-402 P\u0142ock, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6414-9504","authenticated-orcid":false,"given":"\u0141ukasz","family":"Olewnik","sequence":"additional","affiliation":[{"name":"Department of Clinical Anatomy, Masovian Academy in P\u0142ock, 09-402 P\u0142ock, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,10,11]]},"reference":[{"key":"ref_1","unstructured":"Miniato, M.A., and Nedeff, N. (2024). Anatomy, Bony Pelvis and Lower Limb: Sural Nerve. StatPearls, StatPearls Publishing."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1007\/s00401-001-0492-6","article-title":"Quantitative Assessment of the Innervation of Epineurial Arteries in the Peripheral Nerve by Immunofluorescence: Differences between Controls and Patients with Peripheral Arterial Disease","volume":"103","author":"Teunissen","year":"2002","journal-title":"Acta Neuropathol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1055\/s-2002-28464","article-title":"Vascularized Medial Sural Cutaneous Nerve Based on the Superficial Sural Artery: A Reliable Nerve Graft","volume":"18","author":"Riordan","year":"2002","journal-title":"J. Reconstr. Microsurg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1002\/ajpa.1330150115","article-title":"A Study of the Formation of the Sural Nerve in Adult Man","volume":"15","author":"Huelke","year":"1957","journal-title":"Am. J. Phys. Anthropol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1007\/s00276-004-0276-5","article-title":"Peculiarities of the Sural Nerve Complex Morphologic Types in Human Fetuses","volume":"27","author":"Ugrenovic","year":"2005","journal-title":"Surg. Radiol. Anat."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"24","DOI":"10.4103\/0028-3886.60390","article-title":"Anatomical Variations of the Sural Nerve in the Leg: A Fetal Study","volume":"58","author":"Shankar","year":"2010","journal-title":"Neurol. India"},{"key":"ref_7","first-page":"1838","article-title":"Anatomical Variations in Formation of Sural Nerve in Adult Indian Cadavers","volume":"7","author":"Kavyashree","year":"2013","journal-title":"J. Clin. Diagn. Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"151742","DOI":"10.1016\/j.aanat.2021.151742","article-title":"Anatomy of the Sural Nerve Complex: Unaccounted Anatomic Variations and Morphometric Data","volume":"238","author":"Steele","year":"2021","journal-title":"Ann. Anat.-Anat. Anz."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1002\/ca.10016","article-title":"Anatomical Variations of the Sural Nerve","volume":"15","author":"Mahakkanukrauh","year":"2002","journal-title":"Clin. Anat."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1097\/PHM.0b013e318174e569","article-title":"The Effect of Anatomical Variation of the Sural Nerve on Nerve Conduction Studies","volume":"87","author":"Pyun","year":"2008","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.aanat.2015.08.002","article-title":"Anatomical Variations of the Formation and Course of the Sural Nerve: A Systematic Review and Meta-Analysis","volume":"202","author":"Ramakrishnan","year":"2015","journal-title":"Ann. Anat.-Anat. Anz."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1434","DOI":"10.1097\/scs.0b013e3181534a4d","article-title":"Topographic and Histologic Characteristics of the Sural Nerve for Use in Nerve Grafting","volume":"18","author":"Park","year":"2007","journal-title":"J. Craniofacial Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1177\/107110070502600712","article-title":"The Anatomic Features of the Sural Nerve with an Emphasis on Its Clinical Importance","volume":"26","author":"iKiZ","year":"2005","journal-title":"Foot Ankle Int."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1002\/ca.21068","article-title":"Anatomical Variations of the Human Sural Nerve and Its Role in Clinical and Surgical Procedures","volume":"24","author":"Eid","year":"2011","journal-title":"Clin. Anat."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1111\/j.1440-1789.2009.01009.x","article-title":"Usefulness of Sural Nerve Biopsy in the Genomic Era","volume":"29","author":"Kanda","year":"2009","journal-title":"Neuropathology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"144","DOI":"10.5115\/acb.2014.47.2.144","article-title":"Fascial Entrapment of the Sural Nerve and Its Clinical Relevance","volume":"47","author":"Paraskevas","year":"2014","journal-title":"Anat. Cell Biol."},{"key":"ref_17","unstructured":"Vandyke Carter, H. (2024, September 24). Posterior View or Right Leg, Showing the Small Saphenous Vein and the Sural Nerve. Available online: https:\/\/commons.wikimedia.org\/wiki\/File:Gray582.png."},{"key":"ref_18","unstructured":"Steele, R. (2024, September 24). English: Modified Grays Popliteal Fossa Superficial Dissection. Demonstration of the Most Common Formation of the Sural Nerve. Available online: https:\/\/commons.wikimedia.org\/wiki\/File:RobertSteele_SuralNerve_GraysMODified.png."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1953","DOI":"10.1016\/j.ejrad.2013.05.014","article-title":"Ultrasound of the Sural Nerve: Normal Anatomy on Cadaveric Dissection and Case Series","volume":"82","author":"Belsack","year":"2013","journal-title":"Eur. J. Radiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2216","DOI":"10.1007\/s00167-022-07294-8","article-title":"Ultrasound Evaluation of a New Surface Reference Line to Describe Sural Nerve Location and Safe Zones to Consider in Posterior Leg Approaches","volume":"31","author":"Baduell","year":"2023","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1002\/jum.14444","article-title":"Ultrasonography of the Sural Nerve: Normal and Pathologic Appearances","volume":"37","author":"Bianchi","year":"2018","journal-title":"J. Ultrasound Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1186\/s41747-024-00495-5","article-title":"3D Fascicular Reconstruction of Median and Ulnar Nerve: Initial Experience and Comparison between High-Resolution Ultrasound and MR Microscopy","volume":"8","author":"Lechner","year":"2024","journal-title":"Eur. Radiol. Exp."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1002\/mus.28181","article-title":"Sciatic Nerve Fascicle Differentiation on High-Resolution Ultrasound with Histological Verification: An Ex Vivo Study","volume":"70","author":"Snoj","year":"2024","journal-title":"Muscle Nerve"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e298","DOI":"10.3928\/01477447-20140225-64","article-title":"Anatomy of the Sural Nerve and Its Relation to the Achilles Tendon by Ultrasound Examination","volume":"37","author":"Kammar","year":"2014","journal-title":"Orthopedics"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1002\/ca.22997","article-title":"The Surgical Anatomy of the Sural Nerve: An Ultrasound Study","volume":"31","author":"Popieluszko","year":"2018","journal-title":"Clin. Anat."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"636","DOI":"10.1016\/j.ejvs.2009.11.024","article-title":"Ultrasound Imaging of the Sural Nerve: Ultrasound Anatomy and Rationale for Investigation","volume":"39","author":"Ricci","year":"2010","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1111\/jns.12645","article-title":"Initial Findings Using High-Resolution Magnetic Resonance Imaging for Visualisation of the Sural Nerve and Surrounding Anatomy in Healthy Volunteers at 7 Tesla","volume":"29","author":"McDowell","year":"2024","journal-title":"J. Peripher. Nerv. Syst."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1177\/10711007211051750","article-title":"An Anatomic Study of the Sural Nerve Using 3-Tesla MRI: A Comparison to Cadaveric Data with Surgical Applications","volume":"43","author":"Ghetti","year":"2022","journal-title":"Foot Ankle Int."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"108652","DOI":"10.1016\/j.jneumeth.2020.108652","article-title":"MicroCT Optimisation for Imaging Fascicular Anatomy in Peripheral Nerves","volume":"338","author":"Thompson","year":"2020","journal-title":"J. Neurosci. Methods"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1007\/s004150050314","article-title":"Clinical Outcome of Sural Nerve Biopsy: A Retrospective Study","volume":"246","author":"Flachenecker","year":"1999","journal-title":"J. Neurol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3349\/ymj.1990.31.1.1","article-title":"Diagnostic Usefulness and Limitations of the Sural Nerve Biopsy","volume":"31","author":"Oh","year":"1990","journal-title":"Yonsei Med. J."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1053\/j.jfas.2007.01.005","article-title":"Technique of the Sural Nerve Biopsy","volume":"46","author":"Bevilacqua","year":"2007","journal-title":"J. Foot Ankle Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1097\/SAP.0b013e31817e9c8d","article-title":"A Modified Approach to Sural Nerve Biopsy: Minimizing Complications","volume":"62","author":"Ducic","year":"2009","journal-title":"Ann. Plast. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1002\/mus.24494","article-title":"Asymptomatic Vasculitic Neuropathy","volume":"52","author":"Kurt","year":"2015","journal-title":"Muscle Nerve"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"874","DOI":"10.1212\/01.WNL.0000137017.45065.3E","article-title":"Sensory Neuropathy in Vasculitis: A Clinical, Pathologic, and Electrophysiologic Study","volume":"63","author":"Seo","year":"2004","journal-title":"Neurology"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1097\/BOR.0000000000000559","article-title":"Vasculitis and Peripheral Neuropathy","volume":"31","author":"Graf","year":"2019","journal-title":"Curr. Opin. Rheumatol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1002\/mus.26431","article-title":"Vasculitic Neuropathy: Comparison of Clinical Predictors with Histopathological Outcome","volume":"59","author":"Nathani","year":"2019","journal-title":"Muscle Nerve"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1007\/s10072-019-04082-0","article-title":"Sural Nerve Biopsy in Peripheral Neuropathies: 30-Year Experience from a Single Center","volume":"41","author":"Luigetti","year":"2020","journal-title":"Neurol Sci."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1136\/jnnp-2019-320314","article-title":"Chronic Inflammatory Demyelinating Polyneuropathy: Update on Diagnosis, Immunopathogenesis and Treatment","volume":"90","author":"Lehmann","year":"2019","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1007\/978-981-32-9636-7_21","article-title":"Chronic Inflammatory Demyelinating Polyneuropathy","volume":"1190","author":"Kuwabara","year":"2019","journal-title":"Adv. Exp. Med. Biol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1016\/j.ncl.2013.01.006","article-title":"Chronic Inflammatory Demyelinating Polyneuropathy","volume":"31","author":"Gorson","year":"2013","journal-title":"Neurol. Clin."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"938","DOI":"10.1016\/S2213-8587(19)30081-6","article-title":"Diabetic Peripheral Neuropathy: Advances in Diagnosis and Strategies for Screening and Early Intervention","volume":"7","author":"Selvarajah","year":"2019","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"2028","DOI":"10.1111\/jdi.13568","article-title":"Bilirubin Is Inversely Related to Diabetic Peripheral Neuropathy Assessed by Sural Nerve Conduction Study","volume":"12","author":"Abe","year":"2021","journal-title":"J. Diabetes Investig."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1038\/s41574-021-00496-z","article-title":"Pathogenesis, Diagnosis and Clinical Management of Diabetic Sensorimotor Peripheral Neuropathy","volume":"17","author":"Sloan","year":"2021","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"4043","DOI":"10.2337\/dc12-2530","article-title":"Identification of Factors Associated with Sural Nerve Regeneration and Degeneration in Diabetic Neuropathy","volume":"36","author":"Hur","year":"2013","journal-title":"Diabetes Care"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1007\/s40477-024-00875-y","article-title":"Morphometry of the Sural Nerve in Diabetic Neuropathy: A Systematic Review","volume":"27","author":"Ludi","year":"2024","journal-title":"J. Ultrasound"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1016\/B978-0-444-53480-4.00016-3","article-title":"Pathology of Human Diabetic Neuropathy","volume":"126","author":"Malik","year":"2014","journal-title":"Handb. Clin. Neurol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1002\/mus.20580","article-title":"Sural Neuropathy: Etiologies and Predisposing Factors","volume":"34","author":"Stickler","year":"2006","journal-title":"Muscle Nerve"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1097\/00002060-200107000-00017","article-title":"Isolated Sural Neuropathy Presenting as Lateral Ankle Pain","volume":"80","author":"Refaeian","year":"2001","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_50","first-page":"231","article-title":"Sural Neuropathy Produced by Intraneural Ganglion","volume":"29","author":"Acciarri","year":"1990","journal-title":"J. Foot Surg."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1001\/jama.1978.03280290055024","article-title":"Entrapment Neuropathy from Baker\u2019s Cyst","volume":"239","author":"Nakano","year":"1978","journal-title":"JAMA"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1002\/mus.24107","article-title":"Sural Mononeuropathy: A Report of 36 Cases","volume":"49","author":"Yuebing","year":"2014","journal-title":"Muscle Nerve"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1724","DOI":"10.1002\/(SICI)1097-4598(199912)22:12<1724::AID-MUS18>3.0.CO;2-Q","article-title":"Neurophysiological and Ultrasound Findings in Sural Nerve Lesions Following Stripping of the Small Saphenous Vein","volume":"22","author":"Simonetti","year":"1999","journal-title":"Muscle Nerve"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1111\/j.1085-9489.2005.00056.x","article-title":"Isolated Sural Nerve Neuropathies","volume":"10","author":"Oflazoglu","year":"2005","journal-title":"J. Peripher. Nerv. Syst."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1016\/j.fcl.2011.01.006","article-title":"Peripheral Nerve Entrapments of the Lower Leg, Ankle, and Foot","volume":"16","author":"Flanigan","year":"2011","journal-title":"Foot Ankle Clin."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1177\/03635465000280051001","article-title":"Chronic Calf Pain in Athletes Due to Sural Nerve Entrapment. A Report of 18 Cases","volume":"28","author":"Fabre","year":"2000","journal-title":"Am. J. Sports Med."},{"key":"ref_57","unstructured":"Piedra Buena, I.T., and Fichman, M. (2024). Sural Nerve Graft. StatPearls, StatPearls Publishing."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1002\/(SICI)1098-2752(1996)17:4<217::AID-MICR8>3.0.CO;2-H","article-title":"Harvesting of the Sural Nerve with a Tendon Stripper","volume":"17","author":"Jaroszynski","year":"1996","journal-title":"Microsurgery"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1055\/s-0032-1330117","article-title":"Nerve Stripper-Assisted Sural Nerve Harvest","volume":"75","author":"Hassanpour","year":"2014","journal-title":"J. Neurol. Surg. A Cent. Eur. Neurosurg."},{"key":"ref_60","first-page":"360","article-title":"Pediatric Sural Nerve Harvest: A Fully Endoscopic Technique","volume":"64","author":"Spinks","year":"2009","journal-title":"Neurosurgery"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"12","DOI":"10.5152\/eurasianjmed.2019.19102","article-title":"A New Method to Harvest the Sural Nerve Graft","volume":"52","author":"Cinal","year":"2020","journal-title":"Eurasian J. Med."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1177\/107110079401500906","article-title":"The Sural Nerve in the Foot and Ankle: An Anatomic Study with Clinical and Surgical Implications","volume":"15","author":"Lawrence","year":"1994","journal-title":"Foot Ankle Int."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/20\/6055\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:11:10Z","timestamp":1760112670000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/20\/6055"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,11]]},"references-count":62,"journal-issue":{"issue":"20","published-online":{"date-parts":[[2024,10]]}},"alternative-id":["jcm13206055"],"URL":"https:\/\/doi.org\/10.3390\/jcm13206055","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,11]]}}}