Regional anesthesia is increasing in its utility in the treatment of injuries, foreign body removal, and even in the operative setting. By providing a regional block, the affected anatomy can be properly cleaned, explored, and treated without causing unnecessary pain to the patient. In many settings, regional anesthetic is also preferred because it prevents the distortion of the anatomy commonly seen in local anesthesia.
Regional anesthesia of the ankle presents a challenge to the provider because of the complicated nerve supply to the foot and the varied locations of the nerves around the ankle. However, by adequately anesthetizing the foot, patients can be offered relief from often painful injuries while the complex anatomy of the foot is examined and repaired. See for more information.
Providing local anesthesia to the foot, particularly to the sole, presents many difficulties. First, the thick but sensitive skin must be penetrated with a needle, which often must be a larger gauge than might be used elsewhere to pass through the skin — this can be very painful. Second, the underlying soft tissue of the sole is tightly bound to the fascia and does not separate easily; injecting even small amounts of anesthesia locally into the sole can result in compression of blood vessels and vascular damage to the tissue that is already injured. But, with regional anesthesia, each of these difficulties can be avoided by blocking the pain sensation carried from the foot at the point where the nerves pass through a safe, readily accessible region of anatomy.[1]
An image depicting a cross-section of the ankle can be seen below.
Cross-section of the ankle. 
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