What made you interested in this? 

It all started on a regular Friday afternoon in clinic.  

We were chatting, reflecting on how much our profession had evolved.  

We talked about the shift from traditional chiropody to modern podiatry, marvelling at how far our scope had expanded.  

Historically, podiatric surgery revolved around basic digital blocks for nail and hammertoe procedures. As we progressed to first-ray surgery, ankle blocks became routine.  

But suddenly, we were taking on complex procedures around the hindfoot, ankle, and even the leg.  

These operations demanded far greater anaesthetic coverage and superior postoperative pain control. 

That need for extended coverage was the turning point that led us to the popliteal nerve block.  

While our practice initially relied on nerve stimulators, the introduction of ultrasound changed our approach. Learning ultrasound guidance meant acquiring a whole new skill set, but it allowed us to visualise the nerve and the spread of local anaesthetic directly. 

It made our regional anaesthesia precise, accurate and safe, bringing our practice directly in line with national guidance. 

Realising how far we had come made us want to share what we had learnt. 

Fortunately, one of us had the foresight to collect data along the way, quietly trusting that someone down the line would sit down and write the paper!  

We wanted to publish the research to establish some baseline evidence for our expanding scope, invite peer review and show what modern podiatric practice can involve. 

What did you want to find out? 

Going into this study, we already knew that the popliteal nerve block was an option for foot and ankle surgery. Compared to standard ankle blocks, it gives far better coverage for major procedures. 

Compared to spinal anaesthesia or general anaesthetic, it only numbs the leg you are operating on and carries fewer systemic risks. 

We also knew that transitioning from nerve stimulators to ultrasound was supposed to be best practice, offering direct visualisation of the nerve and local anaesthetic spread. 

What was not clear, however, was how well this held up in real-world, podiatrist-led practice in the UK. Almost all the existing literature on ultrasound-guided popliteal blocks came from anaesthetist-led teams. 

On top of that, there was a real lack of evidence evaluating ultrasound blocks when used as the sole form of anaesthesia, without giving patients additional intravenous sedation or putting them under general anaesthetic. 

Having formally made the switch from nerve stimulators in our department back in 2018, we wanted to see our outcomes, so we set out to evaluate the practical effectiveness of our podiatrist-led service.  

Specifically, we hoped the research would tell us how comfortable patients found the injection procedure itself, how fast and reliable the block onset was, how long the pain relief lasted, and how much post-operative pain medication patients needed once they went home.  

Ultimately, we wanted to find out whether our podiatric surgery team could deliver these advanced blocks safely, independently and effectively. 

How did you find out? 

We looked back at the records of patients who received an ultrasound-guided popliteal block for elective foot surgery between March 2018 and August 2020.  

Over this two-and-a-half-year period, we gathered data from a total of 103 consecutive patients.  

These were individuals who were deemed to have a lower tolerance for pain, were undergoing lengthy procedures lasting over 90 minutes, or were having more involved surgery on the midfoot or hindfoot. 

All the blocks were carried out by our team of podiatric surgeons and specialised podiatrists, using a standardised approach.  

We positioned patients comfortably, located the sciatic nerve just above where it splits in the back of the knee, and administered a combination of local anaesthetics – fast-acting lidocaine for quick onset, followed by long-acting levobupivacaine for lasting pain relief.  

Where extra coverage was needed along the inside of the foot, we added a supplementary saphenous nerve block. 

What did you find? 

The headline finding was a high success rate of 93.1%, with 94 out of 101 patients achieving complete surgical anaesthesia from the block alone.  

The block took an average of 22 minutes to achieve full numbness. Patients recorded an average injection pain score of just 2.4 out of 10.  

The nerve block provided an average of 24.9 hours of continuous post-operative analgesia.  

Patients required oral pain medication for an average of four days after surgery. No serious complications or adverse events were recorded during the study.  

In the seven cases where the block was incomplete, a supplementary ankle block provided the additional anaesthesia required, without conversion to general anaesthesia.  

Looking closely at this small number of failures, anatomical differences appeared to be one factor. In some patients, the sciatic nerve split much higher up in the leg, making it deeper and harder to visualise clearly on ultrasound. 

On top of that, our department was still transitioning from old nerve-stimulator methods to ultrasound guidance. While everyone was formally trained, competence requires time and hands-on refinement. This learning curve actually pushed our practice to evolve.  

When a high nerve split made visualisation difficult, clinicians adapted by identifying and blocking the tibial and common peroneal nerves separately within the popliteal fossa.  

For us, what these findings mean in everyday practice is encouraging. A 93% success rate shows that ultrasound-guided popliteal blocks can be delivered successfully within a podiatric surgery service, with an ankle block available where additional anaesthesia is needed. 

The duration of post-operative pain relief was particularly relevant to elective day-case surgery. Patients experienced an average of almost 25 hours of analgesia after the block.  

It allows patients to navigate the most painful post-operative window comfortably at home, ensuring a smooth recovery without having to rely heavily on strong opioids.  

Furthermore, the low injection pain scores help dispel the common fear that popliteal blocks are overly painful or distressing.  

Was anything surprising? 

While our clinical results were largely in line with what we hoped to achieve, the process yielded a few insights that challenged our routine assumptions and made us rethink our technical approach. 

One of the most useful things we learnt was that we needed to reconsider our approach to local anaesthesia. 

We routinely administered 5 mL of fast-acting lidocaine first for rapid onset, followed by 10 mL of long-acting levobupivacaine in sequence.  

However, using lidocaine consumes a significant portion of the patient's maximum allowable safe dose early on.  

Looking back at the data made us question whether we needed to use lidocaine alongside levobupivacaine. Using levobupivacaine alone could potentially leave a greater safety margin if a supplementary block or top-up is required later in the procedure, without risking local anaesthetic toxicity. 

Another profound realisation came from examining our low patient discomfort scores during the injection and what they mean clinically.  

Administering a popliteal nerve block should never be an excruciating experience for the patient.  

Severe, agonising pain during injection is a major red flag that the needle tip may be intraneural rather than safely positioned within the perineural sheath. That is precisely when you run the very real risk of nerve trauma or injury.  

This is where ultrasound is handy in visualising this technical difference that could spell either comfort or complication. Seeing this play out reinforced a crucial principle for our entire team – high patient comfort and procedural safety go hand in hand. Success relies on maintaining meticulous anatomical precision every single time. 

Why does it matter? 

For us, the importance of this study lies in showing what was achievable within a modern podiatric surgery service.  

Our findings suggest ultrasound-guided popliteal blocks can provide an effective option for regional anaesthesia in appropriately selected patients undergoing foot surgery.  

The study also shows what a podiatrist-led model of regional anaesthesia can look like in practice, including within community and acute-based podiatric surgery services. That could give services greater flexibility in how they organise care. 

For patients, effective, long-lasting pain relief without the systemic recovery burden of general anaesthesia or heavy oral opioids can make a significant difference to their day-case surgical experience. 

From a professional development and education perspective, these findings highlight the power of expanding our clinical scope through structured training.  

Learning ultrasound guidance requires investment, practice and a willingness to navigate a learning curve, but it has expanded what our team is able to offer. 

For our profession, publishing baseline evidence like this helps bridge the gap between traditional perceptions and modern podiatric practice, providing peer-reviewed validation that supports the ongoing evolution of our scope. 

It is important, however, not to overstate these findings.  

There are important limitations. This was a retrospective study from a single centre, so our results show what is achievable in our service rather than establishing that the technique itself caused these outcomes.  

We are not suggesting every department must immediately alter its protocol but rather sharing our experience to inspire confidence.  

What happens next? 

The true point of research, they say, is not just to answer existing questions, but to spark new ones.  

The study has already led to another question – how does the popliteal nerve block compare directly to a standard ankle block?  

We have now conducted a comparative study, which is currently under peer review. We are really excited to share those findings soon. 

Beyond direct technique comparisons, there is scope to explore how evolving pharmacology can enhance day-case surgical delivery models. 

Given the growing emphasis on getting patients home safely and comfortably on the same day, exploring adjunctive agents like dexamethasone or liposomal bupivacaine is the logical next frontier.  

With more podiatrists qualifying as independent prescribers, we have an opportunity to lead research into these multimodal approaches.  

Ultimately, we hope our work acts as a stepping stone, encouraging more podiatrists to engage in clinical audit, question routine practice and contribute to the ongoing story of our evolving profession. 

Anything else you think readers should know? 

If there is one overarching takeaway from our journey, it is that research does not need to be an intimidating, ivory-tower endeavour.  

What started off as a casual chat on a Friday afternoon turned into a full research project. 

It taught us that useful clinical research can begin with the everyday questions we ask in clinic or theatre.  

You do not necessarily need a dedicated research unit or a large grant. For us, it started with curiosity, routinely collected data and a supportive team. 

Looking back, what made this project so rewarding was the collaborative spirit across our entire department.  

Learning ultrasound guidance together also created a culture of shared learning within the department. We discussed difficult cases, refined our technique and learnt from one another. 

Our advice to clinicians who have thought about writing up their work is simply to start.  

Collect your data systematically, ask questions about what you’re seeing in practice and consider whether other clinicians could learn from the answers. 

Our profession grows stronger every time a podiatrist shares their story. We hope our experience encourages others to do the same. 

About the research 

Title: Clinical effectiveness of ultrasound-guided popliteal nerve block for foot surgery: A retrospective study 

Authors: Yang Sern Kang, Tommy Chan, Antony Wilkinson 

Journal/publication: Foot and Ankle Specialist 

Date published: 8 July 2026 

Link: https://doi.org/10.1177/19386400261465087 

About the authors

Yang Sern Kang is a Trainee in Podiatric Surgery and an Advanced Clinical Practice Apprentice at Derbyshire Community Healthcare Services NHS Foundation Trust. 

Mr Tommy Chan is a Consultant Podiatric Surgeon at Doncaster & Bassetlaw Teaching Hospital NHS Foundation Trust, Derbyshire Community Healthcare Services NHS Foundation Trust and at the Coriel Orthopaedic Group. 

They are the authors of Clinical effectiveness of ultrasound-guided popliteal nerve block for foot surgery: A retrospective study, of which this article is based.