Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

Regional nerve blocks of the foot and ankle — the ankle block (blocking all five terminal nerves supplying the foot at the ankle level) — enable complete foot anesthesia without general anesthesia or spinal/epidural techniques, and are among the most valuable tools in podiatric surgery, office-based procedures, and emergency evaluation of painful foot conditions. Understanding the anatomy and technique of the ankle block allows safe, effective anesthesia for the entire foot.

Five Nerves of the Ankle Block

The ankle block targets five terminal nerves at the ankle level. The posterior tibial nerve: the largest nerve, supplying the entire plantar foot — injected posterior to the medial malleolus in the groove between the medial malleolus and the Achilles tendon, immediately posterior to the posterior tibial artery pulsation (inject 5–7mL). The sural nerve: supplies the lateral foot and fifth toe — injected between the Achilles tendon and the lateral malleolus (inject 5mL). The superficial peroneal nerve: supplies the dorsal foot and toes 2–5 — blocked by a subcutaneous wheal across the anterior ankle from the medial malleolus to the fibula (inject 7–10mL). The deep peroneal nerve: supplies the first web space and anterior ankle — injected at the level of the tibiotalar joint between the extensor hallucis longus and extensor digitorum longus tendons (inject 3–5mL). The saphenous nerve: supplies the medial ankle and medial foot — blocked by a subcutaneous wheal at the medial malleolus anterior surface (inject 3–5mL). Total volume for complete ankle block: 23–32mL of local anesthetic (lidocaine 1–2% or bupivacaine 0.25–0.5%).

Clinical Applications

The ankle block provides complete anesthesia for all forefoot and midfoot surgical procedures, ingrown toenail surgery, nail avulsion, neuroma injection, and emergency pain management for foot fractures and dislocations. Onset time is 15–25 minutes; duration is 4–8 hours with bupivacaine, providing significant post-operative pain control. Dr. Biernacki at Balance Foot & Ankle utilizes ankle block anesthesia routinely for in-office surgical procedures and painful foot and ankle evaluations, providing effective pain management without sedation. Call (810) 206-1402 at our Bloomfield Hills or Howell office.

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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.

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Ankle Block Anesthesia for Foot Surgery in Michigan

Regional nerve blocks at the ankle provide excellent surgical anesthesia and post-operative pain control for foot procedures. Our surgeons use ankle blocks and other regional techniques to minimize general anesthesia needs and enhance your recovery.

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Clinical References

1. Rudkin GE, Rudkin AK, Dracopoulos GC. Ankle block success rate: a prospective analysis of 1,000 patients. Can J Anaesth. 2005;52(2):209-210.
2. Schurman DJ. Ankle block anesthesia for foot surgery. Anesthesiology. 1976;44(4):348-352.
3. Myerson MS, Ruland CM, Allon SM. Regional anesthesia for foot and ankle surgery. Foot Ankle. 1992;13(5):282-288.