Ankle Block
Thomas O. Clanton
David P. Loncarich
Patient Position: Supine, with the leg slightly elevated.
Indications: Anesthesia and immediate postoperative analgesia for any surgery below the ankle including bunion correction, amputation, tendon repair, fracture open reduction and internal fixation, arthrodesis, and lesser toe correction. The entire foot or only a part of it can be blocked depending on the surgical requirement.
Needle Size: 22-gauge, 38-mm needle.
Volume: 5 to 7 mL per nerve.
Anatomic Landmarks: Five nerves are responsible for the motor and sensory innervation of the foot (Fig. 15-1).
The posterior tibial nerve, a branch of the tibial nerve, travels behind the medial malleolus with the posterior tibial artery and vein before passing through the tarsal tunnel with the tendons of the flexor digitorum longus, flexor hallucis longus, and posterior tibialis. It provides motor innervation to the muscles on the plantar aspect of the foot and sensory innervation to the plantar aspect of the foot. The posterior tibial nerve divides into four terminates branches: (a) the medial plantar nerve, (b) the lateral plantar nerve, (c) the calcaneal sensory branches, and (d) the nerve to the abductor digiti quinti.
The superficial peroneal nerve is a branch of the common peroneal nerve. It travels down the leg deep to the fascia and exits to the subcutaneous tissue approximately 10 to 14 cm above the lateral malleolus. At varying levels it then branches into the medial dorsal cutaneous nerve and the lateral or intermediate dorsal cutaneous nerve. The superficial peroneal nerve is purely sensory and provides sensation to the dorsal aspect of the foot, the lateral aspect of the hallux, and the second through fourth toes.Related posts:
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