The sural nerve is a nerve that provides sensation to the outer aspect of the heel and foot. This nerve is an end branch of a nerve that provides sensation and muscle control to the outer side of the leg, and it runs along and under the outer side of the ankle. The sural nerve provides sensation to a small patch of tissue along the foot behind and including the 4th and 5th toes from the heel, including the outer part of the heel itself. As it is a relatively superficial nerve, it can be easily damaged due to chronic pressure along the outer side the foot, as well as from surgery in the region.
The symptoms of sural neuritis include a stinging or sharp pain to the outer side of the heel or ankle, with pain also possibly shooting along the outside of the foot. Since this nerve supplies sensation to the outer side of the heel, pain there can be mistaken for a condition in the heel itself rather than the nerve. If treatment is not directed to the nerve itself, the pain will continue no matter how much treatment is done to the heel.
As stated before, pressure on the nerve can cause eventual damage. This can include tight boots or prominent seams or sandal straps that cause continued and direct pressure to the nerve region. The nerve can also be damaged at its upper course along the Achilles tendon during Achilles tendon lengthening or repair surgery, and can be irritated by scar tissue that may form following surgery to the outer foot and ankle.
Treatment of sural neuritis may involve icing, anti-inflammatory medication, steroid injections, and ankle support. Physical therapy and shoe changes may also be needed. If the nerve is damaged by scar tissue, a second surgery to release the nerve may be necessary as a last resort. Treatment effectiveness depends on the severity of the entrapment, and can sometimes take awhile before results are seen.