Anatomy Atlases: Illustrated Encyclopedia of Human Anatomic Variation: Opus III: Nervous System: Plexuses: Tibial and Sural Nerves

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Illustrated Encyclopedia of Human Anatomic Variation: Opus III: Nervous System: Plexuses

Tibial and Sural Nerves

Ronald A. Bergman, PhD
Adel K. Afifi, MD, MS
Ryosuke Miyauchi, MD
Peer Review Status: Internally Peer Reviewed

Several variations have been reported in the formation and distribution of branches of these nerves. The point of union of the two branches of the sural nerve (tibial), which connects the medial sural cutaneous with the peroneal communicating branch (arising from the common peroneal nerve), is subject to wide variation. It may be high in the popliteal space or there may be no union at all. The union may occur 3 cm below the origin of the peroneal communicating nerve. The two branches of the sural nerve may arise 3 cm apart about 10 cm above the knee and pierce the medial head of the gastrocnemius muscle before joining the peroneal communicating nerve. The two branches may not rejoin. The sural nerve sometimes supplies the dorsal cutaneous area of the lateral two and one-half toes. The sural nerve may terminate at the lateral border of the foot without providing any digital branches.

When the medial sural cutaneous nerve is joined by the peroneal communicating nerve the combined nerve is termed the sural nerve.

Although the sural nerve is considered a purely sensory nerve, motor nerves have been described in four individuals. Amoiridis, et al. found motor nerve fibers in 15 nerves (4.5%) or in 13 individuals (6.2%) in a study of 331 sural nerves from 207 individuals. The authors suggest that the identification of motor fibers in the sural nerve before biopsy because of important implications for the interpretation of pathologic findings.

Huelke (1958) used his studies and others to construct the following table.

Occurrence of Sural Nerve

Author	Present	Absent Medial sural cutaneous n. becomes the lateral dorsal cutaneous n.	Absent Lateral sural cutaneous n. becomes the lateral dorsal cutaneous n.
Huelke ('58) 198 limbs	80.3	19.2	0.5
Huelke ('57) 352 limbs	80.7	19.0	0.3
Williams ('54) 257 limbs	83.7	16.0	0.4
P'an ('39) 286 limbs	81.5	13.3	5.2
Mogi ('38) 180 limbs	83.3	16.7	-
Ssokolow ('33) 500 limbs	52.6	43.8	3.6
Andreassi ('31) 144 limbs	63.9	34.7	1.4
Kosinski ('26) 118 limbs	40.2	53.8	6.0
Catania ('24) 100 limbs	65.0	29.0	6.0
Bardeen ('06) 76 limbs	59.2	39.5	1.3

References

Aasar, Y.H. (1937-38) A peculair relation of the femoral head of biceps femoris to the common peroneal nerve. J. Anat. 72:305.

Amoiridis, G., Schöls, L., Ameridis, N. and H. Przuntek. (1997) Motor fibers in the sural nerve of humans. Neurology 49:1725-1728.

Barbour, J.R. (1947) Puzzling foot symptoms from abnormal nerve distribution. Med J. Australia 1:275-276.

Bardeen, C.R. (1906-07) Development and variations of the neves nd musculature of the inferior extremity and of the neighboring regions of the trunk in man. Am. J. Anat. 6:259-390.

Catania, V. (1924) Il comporta mento dei nervi cutanei dorsali piede. Arch. Ital. Anat. Embriol. 21:295-331.

Huelke, D.F. (1957) A study of the formation of the sural nerve in adult man. Am. J. Phys. Anthropol. 15:137-145.

Huelke, D.F. (1958) The origin of the peroneal communicating nerve in adult man. Anat. Rec. 132:81-92.

Kosinski, C. (1926) La valeur anthropologique des variations dans l'innervation cutanée des membres inférieurs. Assoc. Anatomistes Comptes Rendus. 21:291-295.

Miller, M.R. and M. Kasahara. (1959) The pattern of cutaneous innervation of the human foot. Am. J. Anat. 105:233-255.

Ssokolow, P. (1933) Zur Anatomie des N. suralis beim Menschen und Affen. Z. Ges Anat. 100:194-217.

Zaluska, S. and Z. Urbanowicz (1971) The tibial and common peroneal nerves in man and macaca. Folia Morphologica 30:167-175.

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