Used to provide regional anesthesia to the foot in order to facilitate the following:

    Primary closure/exploration of foot wounds

    Incision and drainage

    Removal of foreign bodies

    Operative intervention

 Preferred technique because glabrous skin of the epidermis and fibrous septae in the dermis of the foot limit local diffusion of anesthetic

CONTRAINDICATIONS

 Patient refusal

 Infection overlying injection sites

 Relative contraindications: Coagulopathy, systemic infection

LANDMARKS

 There are five nerves which supply the entire surface of the foot (FIGURE 81.1); anatomic landmarks to locate individual nerves are found in the text

TECHNIQUE

 Preparation

    Obtain informed consent

    Position patient supine with knee in flexion and foot placed flat on the gurney

    Sterilize the area of injection with povidone–iodine or chlorhexidine solution

    Drape the area with sterile towels

    Prepare one to three 10-mL syringes filled with anesthetic of choice

    Use 25-gauge to 30-gauge needle

POSTERIOR TIBIAL NERVE BLOCK

 Innervation: Divides into medial and lateral plantar nerves to supply most of the plantar aspect of the foot

 Location: Medial aspect of the ankle between medial malleolus and Achilles tendon

 Technique (FIGURE 81.2)

    Palpate posterior tibial artery posterior to medial malleolus

    Direct needle at 45-degree angle to mediolateral plane, posterior to artery

    At depth of artery (0.5–1 cm deep), move needle slightly to induce paresthesia

    If elicited, 3 to 5 mL of anesthetic is injected after aspiration

    Withdraw 1 mm, then infiltrate 5 to 7 mL of anesthetic while withdrawing 1 cm

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