Answer
Answer
Position the patient supine and as comfortably as possible.
Alternatively, the patient may sit and face the physician.
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Media Gallery
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The posterior tibial nerve courses down the posterior calf.
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Medial and lateral plantar nerves after branching from the posterior tibial nerve.
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Cutaneous innervation by the medial and lateral branches of the posterior tibial nerve.
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Cutaneous innervation of the calcaneal region by the medial plantar nerve.
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The tibialis posterior tendon, flexor digitorum tendon, posterior tibial artery, posterior tibial nerve, and flexor hallucis longus tendon at the ankle level.
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Areas of anesthetization to complete an ankle block. This block requires anesthetization of 5 nerves for complete sensory block below the ankle. The areas to anesthetize include a line along the anterior ankle for the superficial peroneal nerve (blue line), the deep peroneal nerve (red star), the saphenous nerve (pink star), the sural nerve (green arrow), and the posterior tibial nerve (orange arrow).
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Equipment needed for the regional block.
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Posterior tibial nerve block landmarks. Medial malleolus (MM) is at the left and Achilles tendon is at right. Posterior tibial artery (A) is approximately 1 cm inferior to the site marked for needle insertion (arrow).
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Palpation of the posterior tibial artery.
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Marking the injection site, which is 0.5-1 cm superior to the posterior tibial artery.
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Location of injection site when unable to palpate the posterior tibial artery.
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Using povidone iodine solution (Betadine) to clean the injection site.
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Placing a skin wheal.
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Injection posterior and superior to the posterior tibial artery.
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