Sural nerve biopsy is important in diagnosing causes of neuropathy. Peripheral neuropathies are a heterogenous group of disorders with varying etiologies. A systematic approach is required for patient evaluation for cost effective diagnosis. Nerve biopsy has a good diagnostic yield if done in properly selected cases. This is especially so for the asymmetrical neuropathies particularly infectious causes like leprosy, vasculitis and amyloidosis.