Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.
Medically Reviewed by Dr. Jeffery Agnoli, DPM — Board-Certified Podiatrist, Balance Foot & Ankle Specialists, Michigan. Last updated April 2026.
Ankle block anesthesia — the injection of local anesthetic around the five nerves supplying the foot at the level of the ankle — provides complete foot anesthesia for a wide range of in-office and surgical procedures without the systemic effects of general anesthesia, the motor weakness of spinal anesthesia, or the cardiac risk of IV regional anesthesia. Mastering ankle block technique allows podiatric physicians to perform most forefoot procedures, toenail surgery, and wound debridement comfortably in an office or ambulatory surgery center setting.
Ankle Block Anatomy — Five Nerves
Complete ankle block anesthetizes five nerves: Posterior tibial nerve (PTN): the most important — supplies the entire plantar surface of the foot; injected medial to the posterior tibial artery at the level of the medial malleolus; 5–7mL of local anesthetic. Sural nerve: supplies the lateral border of the foot and fifth toe; injected between the Achilles tendon and lateral malleolus; 3–5mL. Superficial peroneal nerve: supplies the dorsum of the foot (except the first web space); injected subcutaneously across the dorsum of the ankle from the extensor hallucis longus to the lateral malleolus; 8–10mL subcutaneous infiltration. Deep peroneal nerve: supplies the first web space; injected deep to the extensor retinaculum at the midpoint of the anterior ankle between the EHL and EDL tendons; 3–5mL. Saphenous nerve: supplies the medial ankle and medial forefoot; injected subcutaneously over the medial malleolus; 3–5mL. Complete block onset: 15–20 minutes with 1.5% mepivacaine or 2% lidocaine; duration 2–4 hours with plain local anesthetic; 6–12 hours with bupivacaine for post-operative analgesia.
Clinical Applications
In-office procedures using ankle block: ingrown toenail removal, toenail avulsion and matrixectomy (digital block is usually sufficient); forefoot wound debridement; lesser toe procedures. Surgical applications: ankle block provides complete foot anesthesia for all forefoot procedures including bunion correction, hammertoe repair, and neuroma excision when combined with monitored anesthesia care (MAC) sedation; reduces the need for general anesthesia; improves post-operative pain control. Contraindications: local infection at injection sites; allergy to local anesthetics; coagulopathy. Dr. Biernacki at Balance Foot & Ankle performs all in-office procedures under appropriate local anesthesia for patient comfort. Call (810) 206-1402 at our Bloomfield Hills or Howell office.
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Our board-certified podiatrists treat this condition at two convenient locations. Same-day appointments often available.
Frequently Asked Questions
What is the best treatment for peripheral neuropathy in the feet?
Treatment depends on the cause. For diabetic neuropathy, blood sugar control is most important. Other options include B12 supplementation, MLS laser therapy, topical creams (capsaicin, lidocaine), and prescription medications like gabapentin or duloxetine. Our podiatrists tailor treatment to each patient’s specific type and severity.
Can neuropathy be reversed?
In some cases — particularly when caused by vitamin deficiencies or early-stage diabetes with good glucose control. However, long-standing nerve damage is often permanent. Treatment focuses on slowing progression, managing symptoms, and preventing dangerous foot complications like ulcers.
How often should I see a podiatrist if I have neuropathy?
Patients with peripheral neuropathy should have comprehensive foot exams every 3–6 months, or more frequently if they have diabetes, poor circulation, or a history of foot ulcers.
Need Treatment at Balance Foot & Ankle?
Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients at our Howell and Bloomfield Township offices.
Book Online or call (810) 206-1402
In-Office Foot Procedures in Michigan
Balance Foot & Ankle performs many foot procedures in-office using ankle block anesthesia — avoiding hospital costs and general anesthesia risks. Quick, effective, and convenient.
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Clinical References
- Rudkin GE, et al. Ankle block success rate: a prospective analysis of 1,000 patients. Can J Anaesth. 2005;52(2):209-210.
- Chmielewski TL, et al. Ankle block for foot surgery: a review. Foot Ankle Spec. 2016;9(2):169-176.
- Myerson MS, et al. Outpatient foot and ankle surgery under local anesthesia. Foot Ankle Int. 2007;28(4):476-481.
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.
- Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
- Heel Pain (APMA)
- Hallux Valgus (Bunions): Evaluation and Management (PubMed)
- Bunions (Mayo Clinic)