Ankle Blocks

Question 1

5 nerves in ankle block

Answer 1

• sural
• saphenous
• superficial peroneal
• deep peroneal
• posterior tibial

*all are from the sciatic nerve, except saphenous is from the femoral

Question 2

ankle block - volume and injection

Answer 2

• 5-6 mL per injection

- do not use epinephrine

Question 3

ankle block - deep peroneal nerve

Answer 3

• branch of common peroneal nerve
• ask patient to flex toes towards head (extensor hallucis longus): located lateral to tendon and artery
• innervate area between first and second toe

Question 4

ankle block - posterior tibial nerve

Answer 4

• branch of common popliteal nerve
• positioned between medial malleolus and Achilles tendon
• 3 branches innervate plantar (bottom) of foot

Question 5

ankle block - superficial peroneal nerve

Answer 5

• branch of common peroneal nerve

- innervate dorsal (top of foot)

Question 6

ankle block - sural nerve

Answer 6

• positioned between lateral malleolus and Achilles tendon

- innervate lateral aspect of foot

Question 7

ankle block - saphenous nerve

Answer 7

• branch of femoral nerve
• slightly anterior to medial malleolus
• innervate medial aspect of foot

Question 8

ankle block - equipment needed

Answer 8

• sterile towels and gauze
• prep solution
• three 10 mL syringes with local anesthetic
• sterile gloves
• one 1.5 inch 25 gauge needle

Question 9

ankle block - technique

Answer 9

• deep nerves: insert until you reach bone, withdraw 1-2 mm, use fan technique (30 degree rotation medial and lateral)
• superficial nerves: complete second