Traction Sural Neuropathy Following Nonoperative Management of Acute Achilles Tendon Rupture: A Case Report

Achilles tendon ruptures are prevalent among physically active adults and can lead to sural nerve injuries (SNIs) due to the anatomical proximity of the sural nerve to the Achilles tendon. While SNIs are well-recognized in surgical contexts, their occurrence following nonoperative treatments, which are often preferred for their lower risk of surgical complications, remains less documented and poorly understood. This report describes a case of a 30-year-old active male who developed chronic traction sural neuropathy after opting for nonoperative treatment of an acute complete Achilles tendon rupture. Despite adhering to a rehabilitation protocol, he experienced persistent symptoms of sural nerve damage, which were confirmed as chronic sensory neuropathy through nerve conduction studies. Here, we discuss the proposed pathophysiology and review the literature on SNIs in Achilles injuries. This case highlights the importance for clinicians to accurately diagnose and remain aware of the potential for SNIs in the nonoperative management of Achilles tendon ruptures.