Certain areas of the foot, especially the plantar surface, are particularly sensitive to the infiltration of a local anesthetic. Lacerations involving the toes are anesthetized using standard digital blocks. Likewise, the lacerations to the dorsum of the foot are sufficiently prepared by local infiltration of lidocaine. Use of epinephrine-containing lidocaine is avoided in toe lacerations. Conscious sedation should be considered for plantar surface lacerations in children. For extensive lacerations, regional nerve blocks are used. Local infiltration of an anesthetic to supplement a regional block is frequently required. The two most commonly used foot nerve blocks are the sural nerve block and the posterior tibial nerve block. The posterolateral aspect of the sole is anesthetized using a sural nerve block, by depositing a generous bandlike deposit of lidocaine 1 cm posterior to the distal aspect of the lateral malleolus. The tibial nerve block numbs the anteromedial aspect of the sole. A posterior tibial nerve block is performed by infiltrating the area just next to the posterior tibial artery just posterior to the distal aspect of the medial malleolus. (See Chap.279.)
Topical anesthetic preparations use lidocaine mixed with any combination of tetracaine, cocaine, and epinephrine. These preparations are poorly effective on the dense epidermis of the sole, especially at the contact areas. Adequate anesthesia with topical preparations can usually be achieved on a dorsal laceration. If topical preparations are used, the blood coagulum is first removed and the solution-soaked cotton pledget is placed firmly into the wound.
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