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General Rehabilitation

Sural Nerve Injury After Ankle Sprain: A Case Report

Thursday, October 23, 2025
12:45 PM - 2:15 PM MT
Location: Kiosk 2

    Poster Presenter(s)

  • Amber Zafar, MA

    Medical Student
    Noorda College of Osteopathic Medicine
    Provo, Utah

    • Co-Author(s)

  • AA

    Ali Arafat, MD

    Resident
    University of Utah PM&R Program
    Salt Lake City, Utah

  • BG

    Bradeigh Godfrey, DO

    Assistant Professor
    University of Utah PM&R Program
    Salt Lake City, Utah

Disclosure(s):
Amber Zafar, MA: No financial relationships to disclose
Ali Arafat, MD: No financial relationships to disclose
Case Diagnosis: Isolated left sural nerve injury after inversion ankle sprain.

Case Description or Program Description: 55 year old male veteran presented to VA EMG clinic 10 months after sustaining a left inversion ankle sprain to evaluate persistent lateral ankle pain and dorsolateral foot burning, with numbness in his lateral foot and 5th toe. His pain worsened while sleeping and would often wake him up at night; it was also aggravated by long distance walking. X-rays were negative for fracture, and he had failed conservative management with physical therapy and NSAIDs prior to being referred to evaluate for nerve injury. Exam revealed normal strength and reflexes, with decreased sensation in his dorsolateral foot and patchy sensation loss across his 1st through 5th digits.

Setting: Veteran’s Affairs EMG clinic.

Assessment/Results: Normal nerve conduction studies were demonstrated in his left superficial peroneal sensory, left tibial motor, left peroneal motor, right peroneal motor, and right sural sensory nerves. His left sural sensory nerve was nonreactive and he was diagnosed with an isolated left sural mononeuropathy. He was referred to an MSK clinic for consideration of a diagnostic sural nerve block and peripheral nerve stimulator.

Discussion (relevance): Sural nerve injuries secondary to ankle injuries have been sparsely documented in literature, primarily in surgical journals after ankle reconstructive surgeries. There have been case reports showing EDX evidence of sural nerve injury after direct ankle trauma1, and reports with clinical diagnoses of sural nerve injury after inversion ankle sprain2,3. To our knowledge, this is the first known instance using NCS to diagnose a sural nerve injury after an inversion ankle sprain.

Conclusions: In patients that present with persistent dorsolateral foot pain with neuropathic features (burning, numbness, paresthesia) after an inversion ankle sprain, sural nerve injury should be evaluated. EDX can be a useful tool for diagnosis in these cases.