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COVID-19, the clinical syndrome produced by infection with SARS-CoV-2, can result in multisystem organ dysfunction, including respiratory failure and hypercoagulability, which can lead to critical illness and death. Musculoskeletal (MSK) manifestations of COVID-19 are common but have been relatively underreported, possibly because of the severity of manifestations in other organ systems. Additionally, patients who have undergone sedation and who are critically ill are often unable to alert clinicians of their MSK symptoms. Furthermore, some therapeutic measures such as medications and vaccinations can worsen existing MSK symptoms or cause additional symptoms. Symptoms may persist or occur months after the initial infection, known as post-COVID condition or long COVID. As the global experience with COVID-19 and the vaccination effort increases, certain patterns of MSK disease involving the bones, muscles, peripheral nerves, blood vessels, and joints have emerged, many of which are likely related to a hyperinflammatory host response, prothrombotic state, or therapeutic efforts rather than direct viral toxicity. Imaging findings for various COVID-19-related MSK pathologic conditions across a variety of modalities are being recognized, which can be helpful for diagnosis, treatment guidance, and follow-up.

High resolution ultrasound (US) and magnetic resonance (MR) neurography are both imaging modalities that are commonly used for assessing peripheral nerves including the sural nerve (SN). The SN is a cutaneous sensory nerve which innervates the lateral ankle and foot to the base of the fifth metatarsal. It is formed by contributing nerves from the tibial and common peroneal nerves with six patterns and multiple subtypes described in literature. In addition to the SN being a cutaneous sensory nerve, the superficial location enables the nerve to be easily biopsied and harvested for a nerve graft, as well as increasing the susceptibility to traumatic injury. As with any peripheral nerves, pathologies such as peripheral nerve sheath tumors and neuropathies can also affect the SN. By utilizing a high frequency probe in US and high-resolution MR neurography, the SN can be easily identified even with the multiple variations given the standard distal course. US and MRI are also useful in determining pathology of the SN given the specific image findings that are seen with peripheral nerves. In this review, we evaluate the normal imaging anatomy of the SN and discuss common pathologies identified on imaging.