ABSTRACT
Technique A 25-gauge 3.8-cm (1.5-inch) needle is inserted perpendicularly to the skin at a point 2 to 5 cm cephalad to the proximal tip of the medial malleolus and midway between the posterior border of the upper malleolus and the medial border of the Achilles tendon. The nerve lies 1 to 2 cm deep to the skin. If a paresthesia is obtained, 5 mL of local anesthetic (epinephrine-free) solution is injected. Alternatively, 7 to 10 mL of solution is injected as the needle is slowly withdrawn from the posterior aspect of the tibia. At the supramalleolar level, blockade is
Cross-sectional view of the ankle. The figure at the level of the malleolus shows the distribution of the terminal branches of the sciatic and femoral nerves.
