Background: Leprosy is a chronic infectious granulomatous disease predominantly involving skin and peripheral nerves, also one of the leading causes of treatable peripheral neuropathy in many developing countries.Nerve function impairment(NFI) is noted in almost 10-15% of new cases, of which a significant proportion of people develop lifelong functional disability.High-resolution ultrasonography (HRUS) is a non-invasive,safe,rapid technique that detects neuropathy before it manifests clinically. Aims and objectives: The study aims to evaluate the role of HRUS in diagnosing clinical and subclinical nerve involvement in leprosy. Patients and methods: This prospective observational study was conducted over 20 months at the DVL department in a tertiary health center. Fifty newly diagnosed leprosy cases and 50 age, sex-matched healthy controls were assessed. Clinical and sonographic data of 3 pairs of nerves (bilateral ulnar, median, and common peroneal) in each individual were recorded and analyzed. Results: Out of 300 nerves analyzed in leprosy patients, 97 showed clinical changes and 186 on HRUS. On HRUS, the changes noted were focal thickening (35%), diffuse thickening (13%), hypoechogenicity (46.3%), and increased vascularity (24.6%). The mean cross-sectional area of nerve in leprosy cases was higher and statistically significant compared to controls. Conclusion: The WHO global leprosy strategy 2021-2030, entitled ‘Towards Zero leprosy,’ focuses on reducing new cases with grade 2 disability by 90%. HRUS is a useful tool in the early diagnosis of NFI and prevention of disabilities.