I have had the sural nerve biopsy...back in '97. It is NOT done often anymore according my neuro at Hopkins.

I can only relay my experiences and what you may encounter might be different. The procedure of course completely severs the nerve so anything below the area will be numb...guaranteed. I did not have the option for any re-attachment with shunt, so don't know the outcome of that. I also experience significant phantom pain that can (and was) disabling. This lasted for almost a year but did lessen slowly over this time period. To this day I have no feeling from the back of my calf down & around the outside of my foot. Have I gotten used to it? Yes, but it took a while.

I did not have the punch biopsy before the nerve biopsy, and frankly don't think it was widely used at this time ('97). I have since had the punch biopsy twice and suggest you at least ask your doctor WHY he's not considering this first since it's less invasive and provides sufficient information for diagnosis of SFN.

The sural nerve biopsy may provide similar results that a punch biopsy would but neither will tell you what is causing it. I also don't know if the nerve biopsy can actually confirm SFN because they are not looking at the small fibers. Mine (nerve biopsy) showed axonal degeneration, but like MrsD said, it doesn't show why and from what.

Did you ask him about the punch biopsy? What was his reply? Do you have positive EMG or NCS that would indicate large fiber neuropathy?