Hadzic's Regional Anesthesia > Part III. Clinical Practice of Regional Anesthesia > Section Six. Blocks for the Lower Extremity > Chapter 39. Ankle Block Joseph Kay, MD, Rick J. Delmonte, DPM, Paul M. Greenberg, DPM

Ankle Block: Introduction

"Foot anesthesia is readily accomplished by blocking the five peripheral nerves that innervate the area by means of local anesthetic deposition either slightly proximal or distal to the malleoli.^1–5 This technique is easily learned and simple to perform, using straightforward visual and palpable anatomic landmarks. It does not require special equipment, paresthesia elicitation, nerve stimulation, special positioning, or patient cooperation.^1–5All types of foot surgery can be carried out with the patient under ankle block, including hallux valgus repair, forefoot reconstruction, arthroplasty, osteotomy, and amputation.^1–10 Ankle block can also provide analgesia for fracture and soft tissue injuries¹¹ and gouty arthritis.¹² Moreover, it can be used for diagnostic and therapeutic purposes with spastic talipes equinovarus¹³ and sympathetically mediated pain.¹⁴ Because motor block of the leg is avoided, ankle block may be preferable to sciatic/femoral (saphenous) nerve block for outpatient forefoot surgery.¹⁵The saphenous, superficial peroneal, and sural nerves are already subcutaneous just proximal to the malleoli, and all can be blocked by a subcutaneous ring of local anesthetic at this location from just anterior to the Achilles tendon medially to laterally (see Figures 39-8, 39-9, and 39-10). The advantage of blocking these nerves here is that the area under an ankle tourniquet will be anesthetized and tourniquet pain is..."