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Introduction: The present paper describes the surgical procedure that typically causes a lesion of the sural nerve and the most common symptoms of such lesion. The medical and legal aspects in relation to the Patient Insurance Association (PIA) are discussed. Materials and methods: The study includes 29 cases with an isolated lesion of the sural nerve during the period 1996 to 2004. We registered gender, age, disease, type of operation, compensable claims, degree of impairment, symptoms, need for medication, supplementary examination, size of compensation, time from operation to filing of claims and time from filing to final resolution. Results: A total of 52% of the lesions were caused by venous surgery, 27.7% by Achilles tendon surgery. A total of 38% of the patients underwent further examination, and 7% had to receive treatment in specialised pain-clinics. The following symptoms were typical: reduced sensibility or numbness, weakness of the foot, reduced range of motion, pain in the heel, radiating pain to the forefoot, more constant burning pain and painful paraestesia or hypersensibility. A total of 52% of the claims were considered compensable, 38% according to "the specialist rule" (Section 2.1.1) and 13.8% according to "the tolerance rule" (Section 2.1.4). The median amount of compensation was DKK 29,731. The mean casework time in the PIA was 278 days. Conclusion: Lesion of the sural nerve most frequently occurs after surgery to the Achilles tendon or after venous surgery, leading to symptoms varying from loss of sensibility to severe hypersensibility and burning paraestesia. With the significant anatomical variation and the documented risk of disabling damage following lesion to the sural nerve, the surgeon needs to be very attentive when operating in the proximity of the sural nerve.

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