Sural Nerve Pain - Causes, Symptoms & Treatment of Neuritis | Pain Care

Sural Nerve Pain – Causes, Symptoms & Treatment of Neuritis

The sural nerve provides sensation to the foot & it’s entrapment can lead to pain in the foot area. Many time it is termed as sural neuritis or sural neuralgia.

It is one of the five nerves that goes down through the center of the calf muscle. Its direction is through the back of the leg, going over the Achilles’ tendon and ending up in the little toe.

When compared to other nerves, the sural nerve is one of the minor ones, as it provides sensation for the outside of the foot, for the areas between the 4th and the 5th toes.

Why do I feel sural nerve pain?

When irritated, the nerve may be capable of creating some pain and discomfort.

Even though anyone could suffer from these problems, sometimes it has something to do with surgery in the area of the foot. Nerve pain after ankle surgery is common in many patient.

When the cause is not surgery, the problem is something athletes may suffer from. It is because the area of their foot is at all times stressed.

Also, because the nerve is located just under the skin, it is particularly susceptible to compression. Tight shoes usually put pressure on the Achilles’ tendon.

When the nerve is compressed between the tendon and the shoe, the compression can cause neuritis.

Another cause of sural neuritis is entrapment. This happens when the nerve gets pulled and trapped in the scar tissue.

This is more serious than the pressure a shoe puts on the nerve. For instance, this kind of pain is much easier to relieve.

Sural Nerve Pain Area Near Ankle

Via – Diabetic Peripheral Neuropathy

The scar tissue involved is often the result of surgery in that region of the foot, so the sural neuritis can be a negative side effect of surgery.

There are a few surgical interventions that may cause this kind of nerve pain.

From these, the most common are:

  • Ankle fracture surgery,
  • Fifth metatarsal surgery,
  • Flatfoot surgery,
  • Achilles’ tendon related surgeries.

This list is not that long, but it is a well-known fact there is a risk of sural neuritis, when these surgeries are being performed.

This pain comes with additional symptoms. For example, you may feel numbing or tingling outside of the foot.

This won’t affect the way you are walking, but it can cause a lot of discomfort.

However, you must be careful as these symptoms may develop over time, and you may end up suffering from neuritis. Be careful when feeling this kind of pain, as many people associate it with the standard pain of being on your feet too much.


Given that this is a specific form of irritation, in a specific area that is also small, it is not that difficult to diagnose this health problem.

With that being said, a specific test for neuritis has not yet been identified. Therefore, your doctor may need to engage in a process of symptoms-elimination.

This means, the doctor will rule other causes until he or she identifies the problem. More than this, the nerve’s location makes it easier for the disease to be confused with Achilles tendon problems.

Many health practitioners are saying that neuritis can often be confused with Achiles tendinitis. On the other hand, this is more related to ankle pronation or supination and not nerve issues.tendinitis. On the other hand, this is more related to ankle pronation or supination and not nerve issues.

So luckily, there are physical symptoms that a medic may be able to observe and rule out in this situation.

Tinel’s test

One test to be done is known as the Tinel’s test. This calls for percussion at the site of the nerve, at the ankle. In case the percussion causes tingling, pins and electric shocks, the test is positive, which is a sign of neuritis.

Other technical measures include radiography. After you have done radiography, you have rules out the problems with the bones in the area.

Radiography may pick up the signs of arthritis or other diseases that are more dangerous and more serious. You could also get a magnetic resonance imaging test, as well.

These tests are being used to rule out the issues you may have with the soft tissues in the area.

Nerve block’s

Lastly, your doctor may think of using diagnostic nerve blocks over the area. The nerve block only does what its name says, it blocks the sensation of pain and discomfort from being sent to the brain.

When the nerve is being paralyzed, there is only the remaining pain to be assessed. In case the pain is finally relieved just by putting the sural nerve to sleep, then it is clear, you may suffer from neuritis.


In case the self-care measures or medication are not working, the treatment for sural nerve pain is surgery.

The sural nerve will respond to cold temperatures, that’s why putting ice on the affected zone would only do good.

Before taking any measure, make sure your shoes are not the ones causing the problem. In case your footwear presses on the Achilles’ tendon, it is time to replace your footwear.

You could also start using anti-inflammatory like ibuprofen. You will not only reduce the pain, but you will also reduce inflammation. These actions will relieve the stress on your sural nerve.

In case your doctor decides for steroid injections, you may want to use them. These will relieve the inflammation and also the stress on the nerve.

Finally, when no more options are left, it may be time for surgery. This will release the entrapped nerve, and other measures will no longer need to be taken.

Before we start to discuss what sural nerve entrapment is, we should recapitulate for a bit, and remember what the sural nerve is. As a matter of fact, we won’t recapitulate but add some new information about the sural nerve and how important it is in the body.

Also referred to as the short saphenous nerve, the sural nerve is located in the lower leg, close to the short saphenous vein.

This nerve is often used for biopsies and nerve grafts. The sural nerve conveys sensory information from the lower calf and outer foot.

If this nerve is damaged, the treatment may be the removal of the nerve, which can result in numbness of the ankle. However, the nearby nerves are going to grow in to compensate.

Because this nerve is just below the skin and it is not that required for essential bodily functioning, doctors often use it when a nerve biopsy is needed.

The biopsy is done with a local anesthetic that is being injected locally. As guidance, the doctor will use the saphenous vein to guide him or her, and after that remove a small part of the nerve.

After the wound has been stitched and closed, the small part of the nerve will be taken to the laboratory and put under the microscope and examined for any nerve health issues.

As said before, the sural nerve is a peripheral nerve. Therefore, it is used to communicate with the brain and the spinal cord. Sural nerve damage is, in fact, a subclass of peripheral neuropathy.

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Sural Nerve Pain – Causes, Symptoms & Treatment of Neuritis
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Sural Nerve Pain – Causes, Symptoms & Treatment of Neuritis
The sural nerve provides sensation to the foot & it's entrapment can lead to pain in the foot area. Many time it is termed as sural neuritis or sural neuralgia.
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Pain Care
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Dr. Sachin

Click Here to Leave a Comment Below 17 comments
Randy Watson - May 8, 2016

Wow! This really hits the nail on the head. I have been telling my doctor for three months exactly what hurts and where. ( outside midfoot, tender and stiff achilles heel, back of calf.) Mainly the outside of my foot near the cuboid bone and metatrarsal. He has given my a few cortizone injections but didn’t help at all!
I used to go through pain management and had a high dose schedule until I decided about four years ago I could live better so I weaned myself off with the help of my pain management doctor. Great success Four years ago. So I’m reluctant to get in the habit of using pain med’s for my foot. Was I so delighted to read this article
that describes my foot pain to the T. This pain has kept me up all night at least 4 to 5 nights in the last three weeks soaking it, heating it, icing it, some pain meds, None of them would stop this aching extreme pain in my foot. Monday morning I going to see my Orthopedic Surgeon and tell him whit I discovered and how it fits. If he doesn’t go in the direction of a temporary nerve block to diagnose this.I’m going across the hall to the neurologist. Thanks again Randy Watson Portland OR. [email protected]

gary archer - May 27, 2016

I had total ankle replacement 2 yes ago now the sural nerve is a mess. I want it removed numbness in foot would be a relief. Agony is putting this mildly.

Jackie - June 26, 2016

Hi i broke my 5th metatarsal 12 months ago and i am still in agony and walking with a limp. Ice packs or ibuprofen 600mg does not take away pain or pins and needles cannot sleep at night with it. This site as described my foot exactly going to see Dr tomorrow and explain what I’ve read. Thank you

    Tara - May 31, 2017

    What did your doctor say? I had the exact thing happen to me June of 2016. I have not been able to wear a shoe, walk sleep or really anything without pain for almost a year. I had ankle ligament reconstruction in October that did not help. The first doctor was a joke, so I went to a different doctor in October and he did the surgery, then PT did not help and he could not figure out why it was still hurting because none of the MRIs or other images including a musculosketal US. He sent me to another doctor that specializes in difficult foot/ankle cases and is the team ortho for 2 of the cities sports teams and he said there might be small tears inside the peroneal tendon and that he also thinks it could be the sural nerve entrapped. I had the surgery 5 days ago and I can wiggle my toes all of them and I have not had any shooting pains. I also have not had to take any meds after the first 2 days.

Tom - July 5, 2016

I have also been suffering with this for the last 4 years. Recently decided I couldn’t take it anymore. Neurologist blew me off. Went to a foot and ankle Dr. and they did the nerve block and then Cortizone shots. Finally I feel some relief and I think I might be able to sleep again without pain. The only thing I found to take the pain away before was to put a back massager under my calf. As long as it was on and moving, I didn’t have any pain. I hope this helps someone.

Graham - February 21, 2017

Had my Sural nerve used for nerve transplant in 1965. Since then I have walked with a slight limp. Hate wearing shoes. Still no feeling in my outer foot and heel.
I am looking to contact others who have similar with Sural nerve removal and do they walk with a limp.
trying to sort out the veterans Affairs department in Australia whose doc says I should not have a limp BUT I do. for the past 50 plus years.

    Phyllis - March 17, 2017

    I too walk with a limp. I have Sural Nerve Neuritis that I just got diagnosed with today. Have asked several drs and finally went to orthopedic. I have found a shoe from sketchers that has lessened my pain. They are the air cooled memory foam ones. The sole is very pliable and keeps some of the pressure off the nerve, they are also light weight. Good luck! Thank you for your service. My husband was in the Navy.

Sol Tan - July 23, 2017

My question is in regards to the last paragraph

“In the event that the nerve is entrapped, shots or physical therapy can help mobilize and separate the scar tissue. Surgery should be the last resort of sural nerve pain.”

What physical therapy can one take to help mobilize and separate the scar tissue? I prefer not to take shots because they are usually temporary solution. Thanks

    Dr. Sachin - July 25, 2017

    A physiotherapist can guide you and advise you the required therapy by examining your pain and other clinical factors. But simple stretching and movement of legs can also help in long run.

ram gupta - August 14, 2017

sir, due to some bacterial infection i have been diagnosed for peripheral neuropathy where sural and perenial nerve etc. are non both foot sole and upper part are numb rest is ok. pl.suggest. thank u.

    Dr. Sachin - November 11, 2017

    Neuropathies take time to heal. You should visit a doctor and get your infection treated asap. Once infection reduces and inflammation subsides, you might see improvement in neuropathy.

TC - September 15, 2017

Can the symptoms for this condition include pain in the calf and up to the ham string area or does it only affect the foot and calf?

Sandy - September 24, 2017

I know this is a old post but if anyone is reading this. I wrapped a bandage around my calf tightly. Needless to say I can walk again with no pain.

Nailah - November 17, 2017

Thank for the information,one month ago it start the Sural pain in my left leg specially when I start walking for 10 min then it is become less pain
So is this nerve problem or muscles ?

    Dr. Sachin - November 17, 2017

    It all depends upon exactly where you get pain, how it gets relieved or become worse and what causes it. Unless and until you see a doctor you will not able to diagnose it. Because in some foot conditions pain gets worse after walking while some get relieved.

Pam - January 30, 2018

I have had horrible “bee stinging” type pain for the last 7+ months in my 3, 4, 5th toes on left food – now beginning in 2nd toe on left and the 2nd toe in my right foot. I’ve tried Gabapentin 900 mg 3 x day, been to the primary doctor, neurologist, podiatrist, spine center, had nerve blocks and cortisone trigger injections, been to an OT that specializes in Neuropathy that uses infrared light treatments, had an MRI of feet and spine, X-ray of spine, and now being referred to pain management. No one knows what else to do. This website about rural nerve entrapment sounds like something that describes my symptoms. I use to cycle a lot, but have been told in the past that cycling doesn’t cause these symptoms. I’m afraid to have nerve ablation because I’m afraid I’ll be unable to feel my feet and walk. The interesting thing is that typically I don’t have symptoms until early afternoon on into the evening every day. There have been several days that I have it 24 hours a day. What else can be done? Is there recommended medication? A further complication is that I recently had a kidney transplant, do there is medication restrictions. I’m in agony each afternoon/night.


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