Abstract
This chapter discusses the surgical procedures that benefit from an ankle block. We discuss how to perform an ankle block using anatomic landmarks, nerve stimulation, and ultrasound. There are five nerves to the ankle, two that are deep beneath the fascia of the ankle—tibial and deep peroneal nerves—and three superficial ones—sural, saphenous, and superficial peroneal nerves. These nerves are small and may be difficult to visualize under ultrasound, so locating associated blood vessels helps. You may also have to scan proximally to confirm the identity of the nerve. If the superficial nerves are difficult to visualize under ultrasound, block them subcutaneously, making a skin wheal, injecting from the medial Achilles tendon to the lateral Achilles tendon. These nerves are also more sensitive to local anesthetic, thus 5 milliliters of local anesthetic per nerve is adequate and effective. Different local anesthetics can be used as long as epinephrine is avoided to prevent vasoconstriction and ischemia.
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