The sural nerve is a sensory nerve that begins in the lateral aspect of the foot and coalesces from branches between the Achilles tendon and lateral malleolus.

The nerve splits into the medial and lateral cutaneous nerves of the leg along the posterior leg.

The larger contributor, the medial sural cutaneous nerve, arises from the tibial nerve in the popliteal fossa between the medial and lateral heads of the gastrocnemius.⁴

The sural nerve runs deep to the investing fascia down the posterior calf between the two heads of the gastrocnemius muscle and then subcutaneously in the distal third of the leg.

It can be found close to, but deep to, the lesser saphenous vein to the ankle.

It is consistently found in the space between the lateral malleolus and the calcaneus tendon.^2,3,4,5

Any history of prior lower extremity operation, either open or endoscopic, should be elicited from the patient.

Physical exam should note any scars or prior incisions on the lower extremities, or numbness or paresthesias in the distribution of the sural nerve.

Prior to sural nerve harvesting, no imaging of the lower extremities is necessary.