Chronic Calf Pain in Athletes Due to Sural Nerve Entrapment

Abstract

We retrospectively analyzed the charts of 13 athletes (18 limbs) who had sural nerve entrapment localized in the passage of the nerve through the superficial sural aponeurosis. There were 11 men and 2 women (average age, 43 years; range, 31 to 59). All patients reported chronic calf pain that was exacerbated during physical exertion. Delay to diagnosis averaged 9 months (range, 5 to 24). Tenderness in the calf was identified along the course of the sural nerve in all cases. In 10 patients (15 limbs) electrodiagnostic testing before surgery was positive. After failure of nonoperative treatment, surgery was conducted under local anesthesia. Neurolysis was performed by incising the superficial sural aponeurosis and the fibrous band in it through which the nerve passes. The results of the operation were evaluated in terms of residual symptoms, ability to return to the former sport, and degree of patient satisfaction. A final follow-up examination was performed an average of 14 months (range, 6 to 30) after the operation. The final result was excellent in 9 limbs (2 bilateral), good in 8 limbs (2 bilateral), and fair in 1 case. The differential diagnosis of sural nerve entrapment in athletes is discussed. Increase in sural muscle mass or development of local fibrous scar tissue compromised the sural nerve in its course through the unyielding and inextensible superficial sural aponeurosis.

Anatomical Variations in Formation of Sural Nerve in Adult Indian Cadavers

“…SN entrapment was seen in one specimen. This abnormal course can produce pain upon contraction of the gastrocnemius muscle or altered sensation over the area of its distribution [19]. Many studies have reported SN entrapment [19][20][21][22].…”

Sport–related peripheral nerve injuries: part 2

“…Repetitive ankle inversion injuries may also lead to fibrosis and nerve entrapment. Sural nerve entrapment 66 can be an underdiagnosed cause of chronic calf and ankle pain, and it has been reported particularly in runners, soccer and tennis players [13].…”

A modified straight leg raise test to differentiate between sural nerve pathology and Achilles tendinopathy. A cross-sectional cadaver study

“…Sural nerve pathology is an uncommon diagnosis (Stickler et al, 2006), but is a condition that may be overlooked as differential diagnosis. For example, a retrospective analysis of 18 elite athletes with suspected chronic Achilles tendinopathy who failed conservative tendon management revealed that sural nerve entrapment was the cause of the symptoms (Fabre et al, 2000). Surgical release of the nerve resulted in positive outcomes.…”

“…Entrapment of the nerve can be caused by compression due to fascial thickening, increased calf muscle mass, local scar tissue or mass-lesions, such as a benign or malignant tumour, haemorrhage or abscess (Fabre et al, 2000;Nicklas et al, 2006;Paraskevas et al, 2014). Ski boots, casts and tight footwear may increase pressure from externally (Brukner and Khan, 2012).…”

“…Sural nerve pathology can mimic Achilles tendon pain and, due to the close proximity of the two structures, differentiation between the two conditions remains difficult (Fabre et al, 2000;Cook et al, 2002). A modified SLR test (SLR SURAL ) has been proposed to differentiate between Achilles tendinopathy and sural nerve pathology (Butler, 2000).…”