Nerve Block: Foot

Background

Dorsal Foot Nerve Distribution

Posterior Ankle Nerve Distribution

Plantar Nerve Distribution

Contraindications

• Overlying site infection
• Injury requiring close neurologic observation (e.g. Compartment Syndrome)
• Allergy to chosen anesthetic
• Underlying Neurologic Damage
• Uncooperative Patient

Equipment Needed

• 10 cc Syringe with a 27 Gauge Needle
• Spare 18 Gauge Needle (to draw up anesthetic)
• Local Anesthetic (e.g. Lidocaine vs Bupivacaine)
• Antiseptic (e.g. Chlorhexidine, Betadine, Rubbing Alcohol)
• Sterile Gloves
• Sterile Drape

Procedure

• Discuss the procedure with the patient regarding desired effects and potential complications
• They should be made aware that they will lose both sensory and motor function appropriate distribution until the anesthetic wears off
• Place the patient's extremity in a position allowing for easy access to the injection site
• Cleanse the appropriate area of skin with chosen antiseptic
• Create a sterile field using your sterile drape

Posterior Tibial Nerve

• Palpate the Medial Malleolus and Achille's Tendon
• The appropriate site is approximately 1 cm superior to the Medial Malleolus and anterior to the Achille's Tendon
• The injection site should be superior and posterior to the area that the Posterior Tibial pulse is felt
• In a sterile fashion, apply a small wheel of local anesthetic to this area
• Directing the needle from medial aspect towards lateral, advance the needle with negative pressure applied to the syringe
• it is important to aspirate prior to injecting anesthetic to rule out Posterior Tibial Arterial placement
• Discontinue and reposition should the patient report shooting "electrical" pains or numbness prior to injection
• Inject approximately 5 mL of local anesthetic

Complications

• Inadvertent intravascular injection
• Infection
• Bleeding/hematoma
• Neurapraxia

See Also

• Nerve blocks (main)
• Local anesthetic systemic toxicity