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Chronic Calf Pain in Athletes Due to Sural Nerve Entrapment

A Report of 18 Cases

Thierry Fabre, MD^*,, Claude Montero, MD, Eric Gaujard, MD, Fabienne Gervais-Dellion, MD^* and Alain Durandeau, MD^*

^* Groupe Hospitalier Pellegrin, Bordeaux, France, Centre de Réeducation des Grands Chênes, Bordeaux, France

Address correspondence and reprint requests to Thierry Fabre, MD, Service Orthopedie Traumatologie A, CHU Pellegrin, Place Amelie Raba Leon, 33076 Bordeaux-Cedex, France

We retrospectively analyzed the charts of 13 athletes (18 limbs) who had sural nerve entrapment localized in the passage of the nerve through the superficial sural aponeurosis. There were 11 men and 2 women (average age, 43 years; range, 31 to 59). All patients reported chronic calf pain that was exacerbated during physical exertion. Delay to diagnosis averaged 9 months (range, 5 to 24). Tenderness in the calf was identified along the course of the sural nerve in all cases. In 10 patients (15 limbs) electrodiagnostic testing before surgery was positive. After failure of nonoperative treatment, surgery was conducted under local anesthesia. Neurolysis was performed by incising the superficial sural aponeurosis and the fibrous band in it through which the nerve passes. The results of the operation were evaluated in terms of residual symptoms, ability to return to the former sport, and degree of patient satisfaction. A final follow-up examination was performed an average of 14 months (range, 6 to 30) after the operation. The final result was excellent in 9 limbs (2 bilateral), good in 8 limbs (2 bilateral), and fair in 1 case. The differential diagnosis of sural nerve entrapment in athletes is discussed. Increase in sural muscle mass or development of local fibrous scar tissue compromised the sural nerve in its course through the unyielding and inextensible superficial sural aponeurosis.