Ankle block

Block of the five nerves supplying the foot, performed slightly proximal or distal to the level of the malleoli, is a simple, safe, and reliable technique that does not require patient cooperation, elicitation of paresthesia, or the use of a nerve stimulator. It can provide anesthesia for any type of foot surgery, thus avoiding the potential complications of general anesthesia or neuraxial block. Ankle block can also supply long lasting analgesia without motor block, allowing early ambulation. Modifications to the original technique, which consist of blocking the deep peroneal and posterior tibial nerves more distally where they are more superficial, have improved the success rate of the ankle block dramatically. By using a technique in which, after the initial injection, subsequent injections are made through previously anesthetized areas, patient discomfort during the placement of the block is minimal. When a tourniquet is required, placement at the ankle is effective, safe, and well tolerated.