Medically Reviewed | Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle, Michigan
Quick Answer: Foot surgery most commonly uses regional block anesthesia (ankle block or popliteal sciatic nerve block), which numbs the foot for 12–18 hours while the patient remains awake or lightly sedated. General anesthesia is reserved for complex or lengthy procedures.
Types of Anesthesia Used for Foot Surgery
Local anesthesia: injection of local anesthetic (lidocaine or bupivacaine) directly into the operative site. Used for very minor procedures — ingrown toenail removal, small lesion excision, simple injections. Duration of numbness: 1–4 hours. Patient is fully awake. No fasting required for purely local anesthesia procedures.
Ankle block: injection of local anesthetic around the five nerves that supply the foot at the ankle level (posterior tibial, sural, superficial and deep peroneal, and saphenous nerves). Produces complete anesthesia of the foot for 8–18 hours depending on the anesthetic agent used. Patient is awake or lightly sedated with IV medications.
Popliteal sciatic nerve block: injection behind the knee targeting the sciatic nerve before it divides — produces anesthesia of the entire foot and lower leg. Duration 18–24 hours. Used for more extensive foot and ankle procedures requiring longer coverage. Performed under ultrasound guidance for precision.
Spinal or epidural anesthesia: injection into the spinal canal or epidural space — numbs from the waist down. Used for bilateral procedures or when regional block is contraindicated.
General anesthesia: complete unconsciousness. Used for complex, lengthy procedures (ankle arthroplasty, major reconstruction), patients with regional block contraindications, or patient preference. Requires NPO compliance and full anesthesia team management.
Advantages of Regional Block Anesthesia
Superior postoperative pain control: the 12–24 hour duration of nerve block anesthesia means the first post-operative night — typically the most painful — is covered by the block. This dramatically reduces opioid requirements and improves patient satisfaction scores compared to general anesthesia alone.
Fewer systemic side effects: regional anesthesia avoids the nausea, vomiting, and cognitive effects associated with general anesthesia. Faster PACU recovery times allow earlier discharge.
Physiologically safer: patients with cardiac disease, pulmonary disease, or other comorbidities who are high-risk for general anesthesia can often safely undergo foot surgery under regional block with light IV sedation.
Dr. Biernacki routinely uses ultrasound guidance for nerve blocks — improving accuracy, reducing drug dose requirements, and minimizing the risk of inadvertent intravascular injection.
What Determines Which Anesthesia Is Used
Procedure length and complexity: simple procedures (15–30 minutes) do well with ankle block. Complex multi-procedure cases (2+ hours) may benefit from popliteal block or spinal/general for complete coverage and surgeon comfort.
Patient anatomy and medical history: obesity, prior ankle surgery (altered tissue planes), anticoagulation, and specific neurological conditions may affect block feasibility or appropriate technique.
Patient preference: some patients are anxious about being awake during surgery. Light IV sedation (twilight anesthesia) with regional block addresses this — patients have no memory of the procedure but do not undergo full general anesthesia with its associated risks.
At Balance Foot & Ankle, Dr. Biernacki’s anesthesia partners specialize in foot and ankle regional anesthesia — expertise that consistently achieves superior block quality and patient satisfaction.
Dr. Tom's Product Recommendations
Doctor Hoy’s Natural Pain Relief Gel
⭐ Highly Rated | Foundation Wellness Partner | 30% Commission
Topical pain relief for when the nerve block wears off — a gentle complementary option
Dr. Tom says: “When the post-surgical nerve block wears off, topical arnica and menthol provide one additional layer of non-systemic pain management alongside oral medications.”
Post-block transition pain, complementary topical relief
Open surgical wounds before full healing
Disclosure: We earn a commission at no extra cost to you.
DASS Medical Compression Socks
⭐ Highly Rated | Foundation Wellness Partner | 30% Commission
Post-surgical graduated compression for surgical edema management after clearance
Dr. Tom says: “Once cleared by Dr. Biernacki (typically 1–2 weeks post-op), DASS compression reduces surgical swelling and accelerates recovery.”
Post-surgical swelling management, recovery acceleration
Before surgical clearance from Dr. Biernacki
Disclosure: We earn a commission at no extra cost to you.
✅ Pros / Benefits
- Regional block provides superior pain control compared to general anesthesia alone
- Fewer systemic complications than general anesthesia
- 12–18 hours of post-operative numbness covers the worst pain period
- Ultrasound-guided blocks improve precision and safety
❌ Cons / Risks
- Some patients experience block failure requiring intraoperative conversion to general anesthesia
- Rare complication: nerve injury from block placement (estimated risk <0.5%)
- Block numbness means careful monitoring is required to avoid traumatizing the numb foot
Dr. Tom Biernacki’s Recommendation
I’m very fortunate to work with an anesthesia team that specializes in foot surgery. A good popliteal block placed under ultrasound gives my patients 18–20 hours of near-complete pain control after surgery. When that block wears off, they’re already 18 hours into recovery — much further along the pain curve than patients who wake from general anesthesia in immediate post-op pain. I advocate for regional anesthesia whenever the patient’s anatomy and condition allows it.
— Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle
Frequently Asked Questions
Will I be asleep during foot surgery?
Not necessarily — most foot surgery uses regional block with optional light sedation. You may be relaxed and comfortable but not fully unconscious.
Can I request general anesthesia?
Yes — patient preference is considered. The anesthesia team will discuss the risks and benefits relative to regional options.
How long does the foot stay numb after surgery?
Ankle block: 8–12 hours. Popliteal sciatic block: 18–24 hours. Your foot may be warm but feel heavy and immovable.
What should I do when the block wears off?
Begin oral pain medication proactively 1–2 hours before the expected block wear-off time. Don’t wait for severe pain to medicate.
Michigan Foot Pain? See Dr. Biernacki In Person
4.9★ rated | 1,123 Reviews | 3,000+ Surgeries
Same-week appointments · Howell & Bloomfield Hills
📞 (810) 206-1402 Book Online →When Shoes Aren’t Enough — Dr. Tom’s Top 9 Orthotics
About 30% of patients I see for foot pain need MORE than a great shoe — they need a structured insole. Below: my complete 2026 orthotic ranking with pros, cons, and the specific patient I’d give each one to.
★ DR. TOM’S COMPLETE 2026 ORTHOTIC RANKING
9 Best Prefab Orthotics by Use Case
PowerStep, CURREX, Spenco, Vionic, and Tread Labs — every orthotic I’ve fitted to thousands of patients across both Michigan offices. Each card includes pros, cons, and the specific patient I’d give it to. Real Amazon ratings, review counts, and prices below.
Best All-Purpose Orthotic for Most Patients
Semi-rigid arch shell + dual-layer cushion + deep heel cup. The orthotic I’ve fitted to more patients than any other for 15 years. APMA-accepted. Trim-to-fit design works in athletic shoes, casual shoes, and most work boots.
✓ Pros
- Semi-rigid arch shell provides true biomechanical correction
- Deep heel cup centers the heel and reduces lateral instability
- Dual-layer cushion (top + bottom) lasts 9-12 months daily wear
- Available in 8 sizes for precise fit
- APMA-accepted and clinically validated
- APMA-accepted with superior cushioning versus rigid alternatives
✗ Cons
- Too thick for most dress shoes (use ProTech Slim instead)
- Some break-in period required (3-7 days for arch tolerance)
- Not enough correction for severe pes planus or rigid pes cavus
Dr. Tom’s Recommendation: If a patient has run-of-the-mill plantar fasciitis, mild flat feet, or arch fatigue, this is the first orthotic I try. Better value than most premium alternatives for 90% of patients, which is why it’s the first orthotic I reach for in the clinic. Sub-$50 typically.
Maximum Motion Control · Flat Feet & Severe Over-Pronation
PowerStep’s most aggressive stability orthotic. Adds a 2°-7° medial heel post on top of the standard PowerStep platform — designed specifically for flat-footed patients and severe pronators who need real corrective force.
✓ Pros
- 2°-7° medial heel post adds aggressive pronation control
- Same trusted PowerStep arch shell, more correction
- Built specifically for flat-foot biomechanics
- Excellent for posterior tibial tendon dysfunction (PTTD)
- Removable top cover for cleaning
✗ Cons
- Too aggressive for neutral-arch patients
- Needs longer break-in (10-14 days) due to stronger correction
- Adds 2-3 mm of stack height — won’t fit slim dress shoes
Dr. Tom’s Recommendation: When a patient comes in with significant flat feet AND symptoms (heel pain, arch pain, knee pain), the Original PowerStep isn’t aggressive enough. The Maxx is what gets prescribed. About 25% of my flat-footed patients end up here.
Low-Profile · Fits Dress Shoes & Narrow Casuals
3 mm slim profile with podiatrist-designed tri-planar arch technology. Engineered specifically to fit inside dress shoes, oxfords, loafers, and women’s flats without crowding the toe box. Vionic was founded by an Australian podiatrist.
✓ Pros
- 3 mm slim profile (vs 7-10 mm for standard orthotics)
- Tri-planar arch technology adds support without bulk
- Built-in deep heel cup despite slim design
- Fits dress shoes WITHOUT having to remove the factory insole
- Trim-to-fit · APMA-accepted
✗ Cons
- Less arch support than full-volume orthotics
- Top cover wears faster than thicker alternatives
- Not enough correction for severe foot deformities
Dr. Tom’s Recommendation: My default when a patient says ‘I need orthotics but I have to wear dress shoes for work.’ Slim enough to fit in oxfords and pumps without the heel sliding out. The single highest-impact change you can make for office workers with foot pain.
Built-In Metatarsal Pad · Morton’s Neuroma · Ball-of-Foot Pain
Standard Pinnacle orthotic with a built-in metatarsal pad positioned proximal to the metatarsal heads — the exact location that offloads neuromas and metatarsalgia. No need for separate met pads or pad placement guesswork.
✓ Pros
- Built-in met pad eliminates DIY pad placement errors
- Specifically designed for Morton’s neuroma + metatarsalgia
- Same trusted PowerStep arch + heel cup platform
- Top cover protects sensitive forefoot skin
- Faster relief than orthotics + add-on met pads
✗ Cons
- Met pad position is fixed (can’t fine-tune individual placement)
- Some patients with very small or very large feet need custom
- Slightly thicker than the standard Pinnacle
Dr. Tom’s Recommendation: If a patient has Morton’s neuroma, sesamoiditis, or generalized ball-of-foot pain (metatarsalgia), this saves a clinic visit and a prescription. The built-in pad placement is anatomically correct for 80% of feet. Way better than DIY met pads.
Adaptive Dynamic Arch · Athletic & Daily Wear
Currex’s flagship adaptive arch technology — the orthotic flexes with your gait instead of fighting it. Different stiffness zones along the length give you targeted support at the heel, midfoot, and forefoot. Available in three arch heights (low/medium/high).
✓ Pros
- Dynamic flex zones adapt to natural gait cycle
- Three arch heights ensure precise fit
- Lighter than rigid orthotics (no ‘heavy foot’ feel)
- Excellent for runners and athletic walkers
- European podiatric design (German engineering)
✗ Cons
- More expensive than PowerStep Original ($55-65 typically)
- Less aggressive correction than Pinnacle Maxx for severe cases
- Three arch heights means you must self-select correctly
Dr. Tom’s Recommendation: I started recommending Currex three years ago for runners who said PowerStep felt ‘too rigid.’ The dynamic flex zones respect natural gait. Best for active patients who walk 8K+ steps daily and don’t need maximum motion control.
Running-Specific · Heel Strike + Forefoot Strike Compatible
Currex’s purpose-built running orthotic. The midfoot flex zone is positioned for runner’s gait mechanics, with a flared heel cushion for heel strikers and a forefoot rocker for midfoot/forefoot strikers. Tested on 1000+ runners during product development.
✓ Pros
- Designed by German biomechanics lab specifically for runners
- Dynamic arch flexes with running gait (not static like PowerStep)
- Three arch heights (low/medium/high)
- Reduces overuse injury risk in mid-distance runners
- Lightweight (no impact on cadence)
✗ Cons
- Premium price ($60-75)
- Not aggressive enough for severe over-pronators (use Pinnacle Maxx)
- Runner-specific design = less ideal for daily walking shoes
Dr. Tom’s Recommendation: If a patient runs 20+ miles per week and has plantar fasciitis or shin splints, this is the orthotic I prescribe. The dynamic flex zones respect running biomechanics in a way that no rigid PowerStep can match. Pricier but worth it for serious runners.
Cavus Foot & High-Arch Patients
Polyurethane base with a deeper heel cup and higher arch profile than PowerStep — built for cavus (high-arched) feet that need maximum cushion and support. The 5-zone cushioning system addresses the unique pressure points of high-arch feet.
✓ Pros
- Deeper heel cup centers the heel for cavus foot stability
- Higher arch profile fills the void under high arches
- 5-zone cushioning addresses cavus foot pressure points
- Polyurethane base lasts 12+ months
- Available in Wide width
✗ Cons
- Too tall/aggressive for normal or low arches
- Won’t fit slim dress shoes
- Pricier than PowerStep Original
- Some patients find the arch height uncomfortable initially
Dr. Tom’s Recommendation: Cavus foot patients are often misdiagnosed and given low-arch orthotics — that makes everything worse. Spenco’s Total Support has the arch profile that high-arch feet actually need. About 15% of my patients have cavus feet; this is what they wear.
Cushion Layer · Standing All Day · Gel Pressure Relief
NOT a true biomechanical orthotic — this is a cushion insole. But for patients who want gel pressure relief instead of arch correction (or to add ON TOP of factory insoles in work boots), this is the best gel option on Amazon.
✓ Pros
- Genuine gel cushioning (not foam pretending to be gel)
- Targeted gel waves under heel and ball of foot
- Trim-to-fit · works in most shoe types
- Sub-$15 price (most affordable option in this list)
- Massaging texture is genuinely soothing
✗ Cons
- ZERO arch support — this is cushion only
- Won’t fix plantar fasciitis or flat-foot issues
- Compresses faster than PowerStep (4-6 months)
- Top cover wears through in high-mileage applications
Dr. Tom’s Recommendation: I recommend these to patients who tell me ‘I just want my feet to stop hurting at the end of my shift’ and who don’t have a biomechanical issue. Construction workers, factory workers, retail. Pure cushion does the job for them.
Tight-Fitting Shoes · Cycling Shoes · Hockey Skates
Tread Labs Pace insole with firm orthotic arch support for flat feet and plantar fasciitis relief. The replaceable top cover design makes it one of the most durable picks in this guide — backed by a million-mile guarantee and recommended for tight-fitting athletic footwear.
✓ Pros
- Firm orthotic arch support shell (podiatrist-grade)
- Slim profile fits tight athletic footwear
- Lasts 12+ months daily wear
- Excellent for cycling shoes specifically
- Built-in odor-control treatment
✗ Cons
- Premium price ($45-55)
- Less cushion than PowerStep equivalents
- Not as aggressive correction as Pinnacle Maxx for flat feet
- The signature ‘heel cup feel’ takes 1-2 weeks to adapt to
Dr. Tom’s Recommendation: If you’re a cyclist with foot numbness, hot spots, or knee pain — this is the orthotic. The stabilizer cap solves cycling-specific biomechanical issues that no other orthotic addresses. Worth the premium for athletes.
None of these solving your foot pain?
Some patients (about 30%) need custom-molded prescription orthotics. We make 3D-scanned custom orthotics in our Howell and Bloomfield Hills offices — specifically built for your foot mechanics.
Schedule a Custom Orthotic Fitting →FSA/HSA eligible · Most insurance accepted · (810) 206-1402
Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.
- Plantar Fasciitis: Diagnosis and Conservative Management (PubMed)
- Plantar Fasciitis (APMA)
- Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
- Heel Pain (APMA)