Patient Position: The patient is positioned supine with the anesthesiologist facing the lateral aspect of the foot.

Indication: Surgery of the forefoot.

Needle Size: 50-mm stimulating needle.

Surface Landmarks: The medial malleolus (Fig. 42-1).

Ultrasound Landmarks: The medial malleolus is an hyperechoic curvilinear structure. The posterior tibial artery and hyperechoic tibial nerve are found posterior and superficial to the medial malleolar bony shadow (Figs. 42-2, 42-3).