Ankle and Foot Nerve Blocks

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

   imagesPrimary closure/exploration of foot wounds

   imagesIncision and drainage

   imagesRemoval of foreign bodies

   imagesOperative intervention

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


imagesPatient refusal

imagesInfection overlying injection sites

imagesRelative contraindications: Coagulopathy, systemic infection


imagesThere 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



   imagesObtain informed consent

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

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

   imagesDrape the area with sterile towels

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

   imagesUse 25-gauge to 30-gauge needle

imagesGeneral Basic Steps

   imagesIdentify landmarks

   imagesPrepare for sterile procedure

   imagesInject anesthetic


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

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

imagesTechnique (FIGURE 81.2)

   imagesPalpate posterior tibial artery posterior to medial malleolus

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

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

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

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


FIGURE 81.1 The sensory nerve supply to the foot. (From Brown DL, ed. Atlas of Regional Anesthesia. 4th ed. Philadelphia, PA: Elsevier Saunders; 2010:135–138.)

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Aug 9, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Ankle and Foot Nerve Blocks
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