Tibial

by | Aug 24, 2021

Indications

  • Lacerations, foreign body, wound exploration of planar foot
  • Calcaneus factures

Contraindications

  • Infection overlying injection site
  • Allergy to local anesthetic

Equipment

  • 5cc of local anesthetic of choice
  • 23-25G needle
  • Cleansing solution
  • Ultrasound with high-frequency linear transducer
  • Ultrasound transducer sterile cover

Preparation

Position

Position the patient with slight hip external rotation and knee flexion to expose the medial malleolus

Ultrasound

Landmarks

  1. Place the transducer posterior to the medial malleolus in a transverse orientation
  2. Identify the tibial artery/vein using doppler flow

The nerve (*) is seen posterior to (right of) the pulsating posterior tibial artery. Also seen is the hyperechoic malleolar cortex of the distal tibia at the bottom of the image, as well as the tendons of tibialis posterior and flexor digitorum longus anterior to (left of) the artery and nerve.

  1. Identify the tibial nerve lateral/posterior to the vascular bundle

Technique

  1. Introduce needle from posterior aspect
  2. In-plane needle visualization
  3. Infiltrate local anesthetic superficial to the tibial nerve (*)

Source

  1. The POCUS Atlas