Unraveling Sural Nerve Entrapment: Diagnosis and Conservative Treatment | OEP369

This episode explores sural nerve entrapment, its causes, symptoms, and effective treatment strategies. We discuss how to differentiate it from lumbar nerve issues, providing insights that can benefit both healthcare professionals and patients alike.

• Overview of sural nerve anatomy and function
• Common causes of sural nerve entrapment
• Key symptoms associated with entrapment
• Strategies for differentiating from lumbar nerve compression
• Treatment options focusing on conservative approaches
• Importance of patient activity and lifestyle considerations
• Recommendations for effective neurodynamic exercises
• Encouragement to broaden perspectives on lower leg pain evaluation and treatment

✅Are you looking for One on one Coaching? We have it!
✅ Hop onto our email list? 👉👉 Click HERE

✅Show sponsor RANGEMASTER.
Get your FREE BlueRanger Pulley: email Jim@myrangemaster.com and enter Ortho Eval Pal in the Subject line.

✅Meet our new Sponsor: Medcor Professionals
Get $10 off of a Saunders Cervical Traction unit: Coupon Code- OEP10

Get $10 off your first order for all other products: Coupon Code-FirstTime10

Support OEP today!

Want to join the OEP community? Click HERE to jump onto our email list. SUBSCRIBE at the bottom of the page.

Ask me your ortho evaluation questions and I will answer them on the show: paul@orthoevalpal.com

Come visit our WEBSITE!! Click HERE to check it out

Be sure to "follow" us on our new Facebook Page

I finally made it to Instagram. Stop by and check us out

Are you looking for One on one Coaching? We have it!

Be sure to check out our 600+ videos on our YouTube Channel called Ortho Eval Pal with Paul Marquis

#heelpain #suralnerve #nervepain #orthoevalpal #podcasts #PTpodcast #medical #health #orthopedics #Physicaltherapy #DPT #Medicalproviders #sportsmedicine #athletictraining #chiropractic #occupationaltherapy

Chapters

• 0:00 Understanding Sural Nerve Entrapment
• 9:25 Conservative Therapy for Sural Nerve Entrapment

Transcript

Speaker 1: 0:00

Hello everyone, and welcome to episode 369 of the OrthoEvalPal podcast. I'm your host, Paul Marquis, and today we're going to be talking about sural nerve entrapment. We're going to be discussing the course of the sural nerve, we'll talk about some of the signs and symptoms of sural nerve entrapment and then we'll go over some treatment tips for sural nerve entrapment. But before we get started, I just want to mention our sponsors. So first we're going to start with Rangemaster. Rangemaster is known for their shoulder rehab equipment. They offer products from shoulder wands to finger ladders, overhead pulleys to shoulder rehab kits. Rangemaster is your one-stop shop to help with the treatment of frozen shoulders, post-op rotator cuff repairs, total shoulders and reverse total shoulder replacements and so much more. If you'd like to get a free sample of Rangemaster's Blue Ranger pulley system, just email jim at myrangemastercom and add OrthoEval Pal in the subject line. And now we also have Medcor professionals. Now, I know the folks at Medcor personally. They're a locally owned and family operated medical supply company. They carry everything from radial pressure wave units to traction devices, resistance bands to compression garments. Most impressively, though, is their customer service. It is second to none. If you're looking for some medical products for your clinic or products for your patients. Go to wwwmedcorprocom, that's M-E-D-C-O-R-P-R-Ocom. If you use coupon code OEP10, you can get $10 off a Saunders cervical traction unit and if you use coupon code FIRSTTIME10, you can get $10 off your first purchase at Medcor Professionals on other products. So, folks, we're back to the show.

Speaker 1: 1:45

It has been absolutely crazy in the world of Paul lately. We're in the middle of revamping our website, so this Thursday we should have our new website up and published and ready to rock. We are also, you know, preparing for a live shoulder course which will be giving in May, and also preparing some live BFR courses to complement our online BFR program. So lots going on over here, along with life and everything else that happens along with all of that stuff. So just a little crazy here. Hope that everything is going well with all of you folks and that you're able to keep everything in line and straighter than I do.

Speaker 1: 2:25

So what I want to talk about today is sural nerve entrapment. Now, this is not something that we see very often, and the reason I want to bring this up is because sometimes we can we can mistake in lateral Achilles discomfort or lateral foot pain for something other than the sural nerve entrapment. So I want to kind of talk about what this nerve does, where it exists and how you manage it when you think you're suspicious that somebody might have it. So you know, the sural nerve is a sensory nerve. It controls sensation to the, you know, the distal third of the lower leg, lateral side, mostly down to the lateral heel, lateral ankle, lateral foot area. It's derived from the sciatic nerve which splits just above the knee going to the tibial nerve and the common peroneal nerve, and then the tibial nerve branches off to the medial sural nerve, the common peroneal nerve branches off to the lateral sural nerve and they come back and converge again just between the heads of the gastroc and just really below that, near the musculotendinous junction, and then it starts to migrate off laterally just along the Achilles tendon down to the posterior lateral malleolar area and then you have a small branch that comes off of that which is your lateral dorsal cutaneous nerve, which can control some sensation to the lateral foot area. So your cerebral nerve controls sensation, a lot of proprioception, so that when people have like neuropathy, this nerve gets affected and it can really throw their gait off. You'll notice that they start to walk with more of a wider base of support, almost like a one-year-old, you know, trying to get their balance. The feet are turned out a little bit. They're really wide, so they start to lose proprioception and that ability to know where the foot is in space. It also helps with temperature sensation and also it can cause pain. So if you have pain in that area it does transmit that. This nerve is very superficial, so just subcutaneous, and that's why it is often picked as a nerve for nerve transplants and things like that or biopsies, because it is so easy to get to.

Speaker 1: 4:48

Now, what causes a sural nerve entrapment? Well, you could have trauma to the sural nerve, which is easy to do. Just a kick to the back of the leg to especially that lateral calf area, lateral Achilles region, can cause some trauma to the nerve itself. You can develop some soft tissue hypertrophy, swelling in that area that compresses the nerve and then you can end up with some scar tissue around that area so that the sterile nerve doesn't glide and move as well anymore. We've seen, you know, injury from, from surgical procedures in that area. I'll always remember when I was a young therapist observing an Achilles reconstruction and the orthopedic surgeon kind of started quizzing me pretty aggressively and asked what this particular structure was, and it was the sural nerve. And he said, interestingly enough, a lot of you know a lot of those get cut because they can look just like a plantarus tendon and it's really difficult sometimes to identify that but it's easy, apparently, to injure.

Speaker 1: 5:54

So you know how do we? How do we treat this? Well, first thing you want to do is you want to make sure that you rule out a lumbar nerve root compression of some sort. Okay, so one of the ways you can do that is do some, some lower quadrant screening, do some reflex testing. A sural nerve entrapment is not going to cause a loss of reflex at the Achilles or at the patella tendon. You will lose sensation in the same area. So that can make it a little bit difficult.

Speaker 1: 6:25

The sural nerve is a sensory nerve, it's not a motor nerve. So you do manual muscle testing throughout the lower extremity to see if there is any unusual weakness. If you see weakness, you need to be thinking upstream a little bit more. The next thing you might want to try is like a straight leg raise test. If it's sural nerve, you could actually get a little stretch, especially if you're doing a Braggers test. So you do the straight leg raise test, you dorsiflex the foot. Now the sural nerve is on a lot of tension. But if you take the foot and plantar flex it and do the straight leg raise, you're less likely to affect that sural nerve. And if it gives them pain, you know. Basically, going down the leg and it's above the knee, more likely to be a nerve root compression up above the knee at the lumbar spine area. So that's how you can kind of tease these out.

Speaker 1: 7:20

So what do you do to treat these? Well, usually there's significant tightness. The calf is tight. Maybe somebody has been really hitting calf strengthening exercises. They develop some hypertrophy there. So getting that calf stretched out, stretching that gastrocnemius muscle a little bit more on a slant board, I like to warm these up.

Speaker 1: 7:40

Getting on a stationary bike isn't going to damage the cerebral nerve. Um, the foot can stay in a very neutral position. Put the foot on the center of the pedal, not on the ball of the. Don't put the the foot on the pedal so that the pedal is on the ball of the foot, because that's going to activate the calf a lot more. So just put that pedal to the center of the foot. Do some biking, get that leg warmed up, I like to use a nice hot pack over that area. This nerve is superficial. Um, I may get the patient kind of long sitting and maybe have them bend the knee and straighten the knee just a little bit, like you know 10 to 15 degrees of flexion, and then get into extension while they have the hot pack on. Also, maybe some very gentle dorsiflexion, plantar flexion, while the heat is there. Ultrasound is very effective in this area because, again, this is very subcutaneous, it's not very deep.

Speaker 1: 8:30

So the other thing you might want to do is start to work on some soft tissue mobilization. Now I wouldn't get in here and really scrape this nerve up hard with a Graston tool or something like that, but maybe just a little light soft tissue mobilization to the gastroc muscle and the surrounding structures, but not to reproduce the symptoms you know significantly. The other thing you want to do is talk about their daily activities, their sports, their hobbies. Do they wear something like a cowboy boot or do they wear a high leather boot where when the top is strapped on it causes compression to that sural nerve? A ski boot a downhill ski boot, classic for putting some pressure on there If you're walking, not so much while you're skiing downhill because your pressure is a little more forward and the knee is a little bit bent. So that helps with that.

Speaker 1: 9:25

Really, the best treatment for this in regards to conservative therapy is sural nerve gliding exercises. By getting the knee into full extension, dorsiflexing the foot and inverting it at the same time will help to get a little bit of the gliding going. So, like any other nerve flossing activity, you don't want to push this so hard that it's very painful and that the reproduction of tingling or burning lasts a long time. You should get it. It should be temporary, while you're doing the exercise, more when you're dorsiflexing and inverting than when you are plantar flexing and everting.

Speaker 1: 10:07

Okay, I like to start these folks doing it passively at first, just to give them a feel, and then I have them start to do it at home. I usually will have them do about. I usually will have them do about, you know, five pumps, about five times. I might also throw in some sciatic nerve flossing while doing this, also just to get the whole sciatic nerve moving and mobilized a little bit better. After this the patient will start doing it on their own and start to, you know, increase that nerve gliding.

Speaker 1: 10:41

You know, walking activities and activities that improve the myofascial mobility throughout the whole back, the leg, can be very beneficial and you want to just make sure that people are not having more tingling, more burning, more loss of sensation. Especially if they're diabetics. They really increase the risk of having some ulceration and nerve injuries, skin injuries on the outer side of the foot. So definitely something to take a look at, keep it in the back of your mind when you see somebody with lateral calf, lateral ankle and foot pain, lateral heel pain also, or loss of sensation there. Something to make sure that you keep an eye on, because it's not something you see very often, but it does exist. And I hope that today's episode kind of brought just another look at another part of the human body that you can kind of, you know, look at with a different perspective so that you don't just get into the same old routine of oh, this is an ankle sprain and this is what this should be, this is how you should treat it. But you need to look outside of the box just to make sure you don't miss anything when you're seeing your patients.

Speaker 1: 11:49

So, um hope you enjoyed today's show. Please be patient with us as we transition to our new website. Lots of moving parts there, um, it's a. It's a big job. It's kept me really busy in the last couple of weeks, but super excited to bring it to folks so that there's just more content, more accessibility and hope. It's everything. You folks need to become more educated in how to do orthopedic evaluations better. So again, folks, be kind to each other and take care.