BLOCK GuRU - Ankle

Tibial

Identify: From anterior to posterior: medial malleolus,

tibial nerve
tibialis posterior, flexor digitorum longus,
artery, nerve, flexor hallucis longus tibialis V
posterior V
A
Target: Surround the nerve with local anaesthetic, using
TIBIAL

flexor digitorum
an in-plane or out-of-plane approach depending longus
on patient morphology V

Tips: The nerve usually lies posterior to the artery and flexor
2 veins. A small ultrasound probe is useful tibia hallucis longus

Avoid: Confusion with tendons which also exhibit

anisotropy on ultrasound (flex the ankle or scan
proximally to distinguish between them).
Excessive probe pressure, intravascular injection anterior posterior anterior posterior

Saphenous

Identify: The long saphenous vein which lies very

superficially, anterior to the medial malleolus;
V saphenous
SAPHENOUS

the nerve accompanies the vein nerve

Target: In the fascial plane around the vein if the nerve

is not directly visible
tibia
Tips: A venous tourniquet can be used to help identify
the vein; use minimal probe pressure and
minimal depth setting to avoid compressing
the vessel

Avoid: Excessive probe pressure, intravascular injection

anterior posterior anterior posterior

Deep peroneal
DEEP PERONEAL

Identify: The small dorsalis pedis artery lies directly on

the subcutaneous surface of the tibia. The nerve extensor tibialis
crosses over the artery from medial to lateral hallucis longus anterior
and this is a reliable sign
A
Target: The nerve as it lies alongside the artery either
on its lateral or medial side
tibia
Tips: Use minimal probe pressure, minimal depth
deep peroneal
setting and scan up and down above the ankle nerve
to see the nerve crossing the artery

Avoid: Excessive probe pressure, intravascular injection

lateral medial lateral medial

Superficial peroneal
SUPERFICIAL PERONEAL

Identify: The anterior border of the fibula in the lower third of extensor
the leg has a characteristic sickle shape on digitorum
ultrasound. The superficial peroneal nerve lies longus
peroneus
superficially and the sharp anterior border of the longus
bone points to the intermuscular septum and the
nerve
superficial peroneal
Target: The nerve in the superficial tissues at any point in fibula nerve
the leg

Tips: Scan up and down at a reasonable speed to identify

the nerve above the bone and intermuscular septum

Avoid: Deep injection

posterior anterior posterior anterior

Sural
sural nerve
Identify: The short saphenous vein runs vertically down the
back of the calf; the sural nerve accompanies the
vein

soleus V tendo
Target: The nerve directly if it is visible, otherwise the achilles
SURAL

fascial plane surrounding the vein(s)

flexor
Tips: Use a venous tourniquet to help identify the short hallucis longus
saphenous vein; flex the knee to leave room for
access with the ultrasound probe

Avoid: Excessive probe pressure, intravascular injection

lateral medial lateral medial

Sciatic Get the App Twitter YouTube

Femoral

Tibial Common peroneal

Android
iPad
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Calcaneal Sural Superficial peroneal

Saphenous Medial plantar Deep peroneal   

Lateral plantar

Anterior Posterior Plantar Dorsal

Saphenous
Deep peroneal
Common peroneal
Medial plantar
Sural
Saphenous
Superficial peroneal Superficial peroneal
Lateral plantar
Medial calcaneal This poster is an educational aid. It should not be used as a sole source of information for a new technique. Variations in anatomy
are to be expected and no responsibility can be accepted for the technical ability of the practioner and individual patient outcomes.

Sural Calcaneal V1-0316

Deep peroneal

GD15_4276_Leonard_Ankle_GURU Aide memoire poster.indd 1 16/03/2016 08:43