A 32 year old male presents with a laceration he sustained after stepping on broken glass at the beach. The examination reveals an 8cm cut on the medial plantar aspect of the left foot. Which peripheral nerve block is appropriate?
**Core Concept**
The posterior tibial nerve is responsible for innervating the plantar aspect of the foot, including the medial and lateral plantar surfaces. This nerve block is useful for providing analgesia to the plantar aspect of the foot, making it an appropriate choice for a laceration in this region.
**Why the Correct Answer is Right**
The posterior tibial nerve is formed by the union of the tibial and common peroneal nerves, and it courses through the tarsal tunnel behind the medial malleolus. The nerve then divides into the medial and lateral plantar nerves, which supply the plantar aspect of the foot. A block of the posterior tibial nerve would effectively anesthetize the area innervated by the medial and lateral plantar nerves, including the medial plantar aspect of the foot where the laceration is located. This is achieved by injecting local anesthetic around the posterior tibial nerve at the level of the ankle.
**Why Each Wrong Option is Incorrect**
**Option A:** The saphenous nerve is a branch of the femoral nerve and is responsible for innervating the medial aspect of the leg, but it does not innervate the plantar aspect of the foot. A block of the saphenous nerve would not provide adequate analgesia for a laceration on the plantar aspect of the foot.
**Option B:** The sural nerve is a branch of the common peroneal nerve and is responsible for innervating the lateral aspect of the foot and the little toe. A block of the sural nerve would not provide adequate analgesia for a laceration on the medial plantar aspect of the foot.
**Option D:** The superficial peroneal nerve is a branch of the common peroneal nerve and is responsible for innervating the lateral aspect of the leg and the dorsum of the foot. A block of the superficial peroneal nerve would not provide adequate analgesia for a laceration on the plantar aspect of the foot.
**Clinical Pearl / High-Yield Fact**
When performing a posterior tibial nerve block, it is essential to identify the posterior tibial artery and vein, as they are often located close to the nerve. Injecting local anesthetic too close to these vessels can lead to complications such as hematoma or nerve damage.
**✓ Correct Answer: C. Posterior tibial nerve**