Morphological Evaluation of the Sural Nerve in Relation to The Achilles Tendon in Human Cadavers

Background: The sural nerve is an important sensory nerve of the lower limb frequently encountered during surgical procedures involving the Achilles tendon and posterolateral aspect of the ankle. Variations in its anatomical course in relation to the tendoachilles may increase the risk of iatrogenic nerve injury during orthopedic and reconstructive procedures. Detailed anatomical knowledge of the sural nerve is therefore essential for improving surgical safety and minimizing postoperative sensory complications. The aim is to study the anatomical relationship of the sural nerve with the tendoachilles in human cadavers and to evaluate its surgical significance. Material and Methods: This descriptive cadaveric study was conducted in the Department of Anatomy over a period of 12 months. A total of 45 lower limbs obtained from embalmed adult human cadavers were dissected and examined. Detailed dissection of the posterior compartment of the leg was performed to identify the sural nerve and its course in relation to the tendoachilles. Parameters assessed included the formation of the sural nerve, its distance from the lateral border of the tendoachilles at various levels, point of crossing, branching pattern, and anatomical variations. The collected data were analyzed statistically and expressed as mean, standard deviation, frequency, and percentage. Results: Among the 45 dissected lower limbs, the sural nerve was formed by the union of the medial sural cutaneous nerve and communicating branch in 34 (75.6%) specimens, while direct continuation without communicating branch was observed in 11 (24.4%) limbs. The mean distance of the sural nerve from the lateral border of the tendoachilles was 2.8 ± 0.5 cm at the musculotendinous junction and 1.2 ± 0.3 cm near the calcaneal insertion. Crossing of the sural nerve toward the lateral border of the tendoachilles was identified predominantly in the distal third of the leg in 29 (64.4%) specimens. Anatomical variations in branching pattern and communication were observed in 9 (20.0%) limbs. Conclusion: The sural nerve lies in close proximity to the Achilles tendon, particularly in the distal third of the leg, making it susceptible to iatrogenic injury during surgical interventions. Adequate anatomical knowledge of the sural nerve and its variations is essential for surgeons performing procedures around the tendoachilles to minimize postoperative sensory complications and improve surgical outcomes.

Keywords: Achilles tendon, Anatomy, Cadaver, Human lower limb, Sural nerve, Tendoachilles.