- Leg Numbing
- Risks and Complications
What is a posterior tibial nerve block?
A posterior tibial nerve block is a procedure for numbing a portion of the foot. An anesthetic injection is administered near the ankle on the inside of the leg, close to the posterior tibial nerve, blocking the transmission of pain signals to the brain.
The posterior tibial nerve is one of the two main branches of the sciatic nerve. The posterior tibial nerve runs down the back of the leg and calf and enables sensory and motor functions of the lower leg and the foot. The posterior tibial nerve block provides anesthesia to the heel, sole of the foot, and the underside of the toes.
Below the ankle, the sensory part of the posterior tibial nerve branches are
- Medial and lateral plantar nerves: transmit sensation of the ball and arch of the foot
- Medial and inferior calcaneal nerves: transmit sensation of the heel pad and the back of the heel
Why is a posterior tibial nerve block performed?
The sole of the foot is extremely tender and sensitive, and direct injection of local tissue infiltration anesthesia in the sole can be difficult and painful. The posterior tibial nerve block provides effective and rapid anesthesia to the heel and sole with fewer injections and less volume of anesthetic agent.
The posterior tibial nerve block is performed:
- For wound repair in the plantar and calcaneal region of the foot
- As part of an ankle block for treatment of ankle dislocation or fracture
- To relieve tarsal tunnel syndrome due to compression of the posterior tibial nerve causing symptoms such as:
- Incision and drainage of abscess in the sole of the foot
- Foreign body removal from the sole of the foot
A tibial nerve block is avoided with the following conditions:
How is a posterior tibial nerve block performed?
A posterior tibial nerve block is an outpatient procedure, most often performed in the emergency department.
The anesthetic agent for a tibial nerve block may be
- Lidocaine for short and fast acting blocks
- Ropivacaine for longer lasting blocks
For children and noncompliant adults, the doctor may also use a topical application of lidocaine mixed with
- Tetracaine or
The doctor may add a buffering solution such as sodium bicarbonate. The anesthetic solution may be warmed to body temperature to reduce the injection pain. Children and elderly patients may require mild sedation as well.
Doctors generally avoid adding epinephrine to the anesthetic agent for nerve blocks in the foot but may occasionally add diluted epinephrine to achieve longer-lasting anesthetic effect and a bloodless operating area (epinephrine constricts the blood vessels).
- The patient lies flat with the inside of the ankle turned out.
- The doctor performs a physical examination to assess the patient’s muscle, nerve, and circulation functions.
- The doctor palpates (prods with fingers) the region next to the ankle to locate the tibial artery and mark the injection site.
- The injection site is sterilized with an antiseptic solution.
- May use ultrasound guidance during the procedure for accurate positioning of the needle.
- Inserts the needle and injects a small amount of anesthetic into the tissue under the skin to raise a bump (wheal).
- Advances the needle through the skin wheal deeper and close to the tibial nerve.
- Aspirates the syringe to make sure it is not inside a blood vessel.
- Slowly injects the anesthetic in the space between the tibial artery and the posterior tibial nerve avoiding direct contact with the nerve.
- Withdraws the needle and massages the injection site gently to help the solution spread in the tissues.
- Waits for up to 10 minutes for the nerve block to take effect.
- If there is a fracture and hematoma, may also administer an injection into the hematoma.
How long does a posterior tibial nerve block last?
The duration of the posterior tibial nerve block’s effects depends on the kind and quantity of anesthetic agent used. Approximate period of anesthetic effects is:
- Lidocaine: Up to three hours
- Lidocaine with diluted epinephrine: Up to seven hours
- Ropivacaine: Up to six hours
Post-procedural pain after the nerve block wears off can be relieved with oral painkillers.
What are the risks and complications of a posterior tibial nerve block?
A posterior tibial nerve block is a low-risk procedure. Potential complications include:
- Infection at the injection site
- Injection into an artery leading to vascular spasm
- Injection into a vein leading to systemic toxicity
- Injury to the tibial nerve or a blood vessel
- Bleeding and hematoma
- Tingling, numbness or muscle weakness (neuropathy)
- Allergic reaction to the anesthetic
- Unsuccessful nerve block
Latest Chronic Pain News
Daily Health News
Health Solutions From Our Sponsors
Top How Long Does a Posterior Tibial Nerve Block Last Related Articles
Broken BoneA broken bone is a fracture. There are different types of fractures, such as:
- vertebral compression,
- compound, and
Symptoms of a broken bone include pain at the site of injury, swelling, and bruising around the area of injury. Treatment of a fracture depends on the type and location of the injury.
Broken FootA broken foot is a common injury. There are 26 bones in the foot, and these bones can be broken (fractured) in a variety of ways. Signs and symptoms of a broken bone in the foot are pain, swelling, redness, bruising, and limping because the person is not able to walk on the affected foot. You can tell if you have a broken foot by medical examination that includes imaging studies. The healing and recovery time for a broken bone in the foot depends upon the type of fracture and the bones broken.
Broken Toe PictureA commonly injured area of the body is the foot, more specifically, the toes (phalanxes). This often causes one or more of the toe bones to break (fracture).
Burns (First Aid)
Burn types are based on their severity: first-degree burns, second-degree burns, and third-degree burns. First-degree burns are similar to a painful sunburn. The damage is more severe with second-degree burns, leading to blistering and more intense pain. The skin turns white and loses sensation with third-degree burns. Burn treatment depends upon the burn location, total burn area, and intensity of the burn.
Cuts, Scrapes, and Puncture WoundsCuts, scrapes, and puncture wounds are common, and most people will experience one of these in their lifetime. Evaluating the injury, and thoroughly cleaning the injury is important. Some injuries should be evaluated by a doctor, and a tetanus shot may be necessary. Treatment will depend upon the severity of the injury.
First Aid and CPRFirst aid is providing medical assistance to someone a sick or injured person. The type of first aid depends on their condition. Preparedness is key to first aid, like having basic medical emergency kits in your home, car, boat, or RV. Many minor injuries may require first aid, including cuts, puncture wounds, sprains, strains, and nosebleeds. Examples of more critical first aid emergencies include heart attacks, strokes, seizures, and heatstroke.
When to Call 911It’s not always easy to tell the difference between a minor bump on the head and a serious head injury. Here are some situations that need medical help right away.
First Aid: Bandaging Injuries and Wounds From Head to ToeBandaging a wound like a burn, cut, or scrape requires different techniques depending on which part of the body was hurt. Ace bandages, liquid bandages, bandage wraps, waterproof bandages, elastic bandages, and other types are available to cover and protect your wound from dirt and water.
First Aid: Wound Care for Cuts and ScrapesWound care treatment at home involves performing cuts and scrapes first aid including cleaning the injury and applying antibiotic ointment and a bandage. Use wound care products like adhesive bandages, hypoallergenic bandages, sprays, tape, and gauze. If cuts and scrapes don’t heal, see your doctor.
First Aid EssentialsAre you always prepared for a first aid crisis? See which basic first aid items to pack to treat minor scrapes, cuts, and stings when you're on the go.
How Long Does a Superficial Peroneal Nerve Block Last?A superficial peroneal nerve block is a procedure to anesthetize a portion of the lower leg and the upper (dorsal) foot. A line of anesthetic injections are administered at the lower end of the front of the leg at the level of the bony projections (malleoli) on either side of the ankle.
How Long Does an Epidural Nerve Block Last?An epidural nerve block is a procedure to block pain by injecting anesthetic medication into the epidural space of the spine. The procedure numbs the relevant nerve region thereby blocking the transmission of pain signals from those nerves to the brain. An epidural nerve block may be administered in the cervical, thoracic, lumbar or the caudal (lowermost) region of the spinal column.
Nerve BlocksNerve blocks are used for different pain treatment and management purposes. There are many different types of nerve blocks for specific areas of the body. A plexus or ganglion is a group of nerves that causes pain to a specific area of the body. The pain area is injected with a nerve-numbing substance called a nerve block.
What Is a Sural Nerve Block?A sural nerve block is a procedure for anesthetizing a part of the calf, lower leg, heel and foot. An anesthetic solution is injected adjacent to the Achilles tendon on the outer side of the foot. The anesthetic blocks the transmission of pain signals from injury or surgery in these parts of the lower leg.
What Is an Epidural Nerve Block?An epidural nerve block is a procedure to block pain by injecting anesthetic medication into the epidural space. The epidural space is the area between the inner wall of the backbone (vertebral column) and the outermost of the three membranes (dura mater) that surround the spinal cord.