A New Era of Local Anaesthesia for Podiatrists: What 2025 Research Means for Your Clinic | Find Your Stride | Edinburgh Podiatrist

Overview

A 2025 Medicina systematic review by Trevissón Redondo et al. examined the effectiveness and safety of local anaesthesia techniques used by podiatrists. With pain control and patient comfort central to modern podiatric surgery, this study offers valuable insights into which methods deliver optimal outcomes in both clinical and outpatient settings.

The review followed PRISMA guidelines and analysed literature from the past decade, screening 485 studies across PubMed, Scopus, and Web of Science. Ultimately, nine studies met the inclusion criteria, focusing on anaesthesia types such as WALANT, ultrasound-guided peripheral nerve blocks (PNB), and preventive local anaesthesia.

With pain control and patient comfort central to modern podiatric surgery local anaesthesia is used often

Key Findings

1. Local anaesthesia is safe and effective in podiatric procedures: Across the included studies, local techniques consistently provided strong pain control and high patient satisfaction with minimal complications.

   
   

2. WALANT (Wide-Awake Local Anaesthesia No Tourniquet)

   • Demonstrated excellent results in forefoot and ankle surgeries.

   • Patients experienced low pain and anxiety, faster recovery, and avoided tourniquet-related discomfort.

   • Especially suitable for minor to moderate procedures in outpatient or office-based settings.

   
   

3. Ultrasound-Guided Peripheral Nerve Blocks (PNB)

   • Proved highly effective in diabetic and high-risk patients, including those on anticoagulants.

   • Improved intraoperative hemodynamic stability and postoperative pain control.

   • Recommended for distal amputations, debridement, and complex foot surgeries.

   
   

4. Subparaneural Injections

   • Provided faster onset and reduced anesthetic volume requirements compared to traditional injections.

   • Increased patient comfort and satisfaction.

   
   

5. Combination Techniques

   • Preventive local anesthesia used alongside general or spinal anesthesia reduced postoperative pain.

   • Suggested for longer or more complex surgeries (e.g., hindfoot or reconstructive procedures).

     
     

Safety and Clinical Implications

The review highlights a low incidence of complications associated with local anaesthesia in podiatry. Adverse events, when present, were mild and typically transient.

However, the authors emphasise that technique accuracy and clinician expertise are critical for minimising risk — especially for advanced methods like ultrasound-guided injections or WALANT. Adequate training and anatomical understanding are essential.

Importantly, patient factors (such as comorbidities, vascular status, and anxiety level) should guide anaesthetic choice. Personalised anaesthesia plans can further enhance outcomes and patient experience.

Recommendations for Practice

For clinical podiatrists, the review supports:

• Adopting WALANT for outpatient forefoot and soft-tissue surgeries.

• Using ultrasound-guided PNBs for high-risk or diabetic patients requiring precise pain control.

• Considering multimodal approaches, such as combining local and spinal anesthesia for complex cases.

• Investing in ultrasound training to expand in-clinic procedural capabilities and safety.

Limitations

While promising, the evidence base remains relatively small, with only nine studies meeting criteria. The heterogeneity of study designs and limited long-term data (e.g., chronic pain or nerve recovery) mean further research is needed before standardised protocols can be established.

The Takeaway for Podiatrists

This systematic review affirms that modern local anaesthesia techniques are transforming podiatric surgery, enhancing both safety and patient comfort.

Techniques like WALANT and ultrasound-guided nerve blocks align with the ongoing shift toward minimally invasive, outpatient care, allowing podiatrists to perform a wider range of procedures efficiently and comfortably — without relying on general anaesthesia or tourniquets.

In short, local anaesthesia in podiatry is no longer just an adjunct — it’s becoming a cornerstone of advanced, patient-centered practice.

Citation

Trevissón Redondo, B., Lago García, N., García Fernández, R., Pereiro Buceta, H., Painceira Villar, R., Gonzalez Garcia, A., Bermejo Martínez, D., Calvo Ayudo, N., & Quiroga-Sánchez, E. (2025). Efficacy and safety of different local anesthesia techniques in podiatric procedures. Medicina, 61(4), 588. https://doi.org/10.3390/medicina61040588

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