Anatomy
- Formed in the calf from the medial sural cutaneous nerve (tibial) and the peroneal communicating branch
- Runs with the small saphenous vein
- Crosses the lateral border of the Achilles tendon about 10 cm above its insertion
- Passes behind the lateral malleolus and continues along the lateral border of the foot
- Level of formation varies and the communicating branch can be absent
- Lateral calcaneal branches supply the lateral heel
Sensory Supply
- Posterolateral distal leg
- Lateral heel and lateral border of the foot to the fifth toe
Clinical Features
- Numbness or painful neuroma after Achilles repair, lateral calcaneal approaches, peroneal tendon surgery and fifth metatarsal fixation
- Most frequent donor for nerve grafts and nerve biopsy
- Compression by tight footwear or a ganglion along the lateral foot
Investigations
- Diagnostic block
- Ultrasound for a neuroma
Differential Diagnosis
- S1 radiculopathy
- Peroneal tendon disorders
Management
- Identify and protect during lateral hindfoot surgery
- Excision of a painful neuroma with proximal burial
- Graft harvest leaves lateral foot numbness, which most patients tolerate
Structures at Risk
- Percutaneous and lateral incision Achilles repair
- Extensile lateral approach to the calcaneus
- Posterolateral ankle arthroscopy portal
- Fifth metatarsal base screw fixation, so use blunt dissection
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.