Wide-Awake Foot and Ankle Surgery

NewsBot · Oct 6, 2016

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Wide-Awake Foot and Ankle Surgery: A Retrospective Analysis
A. Luke MacNeill et al
Foot and Ankle Surgery; Article in Press

Highlights
•We assess the patient experience associated with “wide-awake” foot and ankle surgery.
•Former patients were surveyed about their perioperative anxiety, pain, and satisfaction.
•Patient anxiety was low and decreased steadily over the perioperative period.
•Patients generally experienced little or no intraoperative pain.
•Patients reported high satisfaction with their surgical experience.
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Background
The “wide-awake” approach to foot and ankle surgery is characterized by a surgeon-administered mixture of local anesthetic and epinephrine. No tourniquet, sedation, or general anesthesia are required for surgery. This paper describes a retrospective survey of the initial patients to undergo wide-awake foot and ankle surgery at our center.

Methods
Thirty former wide-awake patients were surveyed about their perioperative anxiety, pain, and satisfaction.

Results
Twenty-seven of 30 patients (90%) completed the survey. Patients received a variety of forefoot, hindfoot, and lower leg procedures. In general, they reported a decrease in anxiety over the course of the perioperative period (p = .005). Pain fell from the preoperative to the intraoperative period, then rose to preoperative levels during recovery (p < .001). Most patients said that the surgery was better than expected (83%); would choose wide-awake surgery for a subsequent procedure (87%); and would recommend wide-awake surgery to someone who required surgery (88%).

Conclusions
Results indicate that the wide-awake approach to foot and ankle surgery causes little discomfort to patients who receive many common procedures. The removal of hindfoot hardware under local anesthesia is contraindicated.
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Admin2 · Oct 6, 2016

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bob · Oct 7, 2016

NewsBot said: ↑

Wide-Awake Foot and Ankle Surgery: A Retrospective Analysis
A. Luke MacNeill et al
Foot and Ankle Surgery; Article in Press
Click to expand...

So removal of rearfoot hardware is absolutely contra-indicated in 'wide-awake' surgery is it? OK. I'll reserve those procedures to the end of my list when I'm half asleep shall I? See what that does to my outcomes! What a pointless article.

NewsBot · Jul 26, 2020

The use of the wide-awake local anesthesia no tourniquet technique in foot and ankle injuries
Yenel Gürkan Bilgetekin et al
Foot Ankle Surg. 2020 Jul 9

Purpose: Although the wide-awake anesthesia no tourniquet (WALANT) technique has demonstrated high efficacy, safety, patient satisfaction, and cost-effectiveness in hand surgery, there are limited data on its use in foot and ankle surgery. This study aimed to evaluate the efficacy of the WALANT technique in selected foot and ankle injuries in terms of intra- and post-operative characteristics.

Material and methods: Patients with foot and ankle injuries who underwent surgery with the WALANT technique were evaluated in this retrospective study. A total of 31 patients (22 male/9 female) with a mean age of 40 ± 16 years were evaluated for the type of injury, underlying comorbidities, American Society of Anesthesiologists Classification (ASA) score, intraoperative visual analog pain (VAS) and anxiety (VAS-A) scores, duration of operation, complications, need for intensive care and duration of hospitalization.

Results: There were 15 patients with medial malleolus fracture, 5 with lateral malleolus fracture, 5 with Achilles tendon ruptures, 2 with proximal phalangeal fracture, and 1 with Lisfranc injury, medial malleolus + syndesmotic injury, deltoid ligament + syndesmotic injury and fifth metatarsal fracture. ASA I-II score was determined in 27 patients and ASA III score in 4. The mean operation time was 36.6 ± 7 min, and the mean length of hospital stay was 8.3 ± 6.1 h. The median VAS pain score was 1 (range, 0-4), the median VAS-A score was 1 (range, 0-3) and no patient needed further anesthetics during the operation. No patient needed intensive care unit stay and no complications were observed in any patient.

Conclusion: The WALANT technique was seen to provide satisfactory anxiety and pain scores, acceptable complications, and a short length of hospital stay in patients with foot and ankle injuries. Simple foot and ankle injuries can be managed successfully with this technique through adequate hemostasis without a tourniquet.
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NewsBot · Aug 3, 2022

Metatarsal osteotomy for hallux valgus under wide-awake local anesthesia with no tourniquet technique
Çağdaş Pamuk
Jt Dis Relat Surg. 2022;33(2):367-373

Objectives: The issue of performing a hallux valgus operation with the wide-awake local anesthesia with no tourniquet (WALANT) technique has not been evaluated before. The objective of this study was to compare the clinical results of patients who underwent the WALANT technique during hallux valgus operation and patients who underwent the procedure with traditional anesthesia (TA).

Patients and methods: In this cross-sectional, retrospective study, 34 patients (17 males, 17 females; mean age: 46.1±8.3 years; range, 36 to 62 years) who underwent first metatarsal osteotomy with the diagnosis of hallux valgus disease between November 1, 2018, and June 1, 2020, were divided into two groups according to the surgical approach determined by patient choice: the WALANT group and the TA group. Demographic characteristics, Visual Analog Scale (VAS) scores for pain and anxiety, postoperative satisfaction levels, and complications were recorded.

Results: There was no significant difference between the groups in terms of demographic characteristics. The VAS pain score during needle insertion was significantly higher in the WALANT group compared to the TA group (p<0.001). Conversely, the VAS anxiety score was significantly higher in the WALANT group compared to the TA group (p<0.001). The median follow-up time was 5.4 months (interquartile range, 5-6 months).

Conclusion: This is the first study demonstrating that adequate anesthetic efficacy can be achieved with the WALANT technique for the hallux valgus operation. Acceptable pain scores can be achieved with this technique, and costs are reduced.
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NewsBot · Jan 2, 2025

Wide Awake Local Anaesthesia No Tourniquet Surgery of the Foot and Ankle: A Review of Indications, Technique, Patient Satisfaction, and Complications
Muhammad A Hamid et al
Cureus. 2024 Dec 1;16(12):e74939.

Wide-awake surgery of the hand was surrounded by a lot of apprehension, mainly over concerns around using epinephrine near digits and its potential to cause digital ischemia and necrosis. With multiple reports underlining its safety and effectiveness, it is now being widely adopted in hand and wrist surgery. The British Society for Surgery of the Hand has already published guidelines on operating outside of main theatres, with an emphasis on wide awake local anaesthesia no tourniquet (WALANT). However, the same cannot be said for its use in foot and ankle procedures. There have been a handful of reports describing WALANT in bony and soft tissue procedures of the foot and ankle, with varied success. We aim to describe the scope of WALANT in these procedures and explore in detail its current role in the domain of lower extremity wide-awake surgery.
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NewsBot · Jul 26, 2025

Efficiency of the combination of Wide Awake Local Anesthesia No Tourniquet (WALANT) and sciatic nerve block for Achilles tendon repair: A preliminary study of feasibility
Sébastien Bloc et al
Source

Background
Various anesthetic techniques are available for surgical repair of Achilles tendon rupture. The main limitation of peripheral nerve blocks is the risk of failure that can be attributed to the failure of the "tourniquet" block or of the “surgical” block.
Purpose
This retrospective study assessed the feasibility and the reproducibility of the association of WALANT technique to sciatic nerve block for Achilles tendon repair surgery.
Study Design
Data from 34 adult patients scheduled for Achilles tendon repair were collected retrospectively from January 2022 to April 2023.
Methods
Sciatic nerve block (15 ml of Ropivacaine 0.375%) and WALANT (30 ml of lidocaine 1% with epinephrine) were performed under ultrasound guidance 30 minutes before surgery. A pneumatic thigh tourniquet was applied but not inflated. The primary endpoint was the efficiency of the combination of sciatic nerve block and WALANT, defined by anesthetic and hemostasis qualities.
Results
Efficacy of the combination of sciatic nerve block and WALANT was 91.2%: one patient required sedation due to pain during skin incision (percutaneous technique), and two others due to discomfort. The hemostatic quality of WALANT was appropriate in 100% of cases, no pneumatic tourniquet was required.
Conclusion
The combination of sciatic nerve block and WALANT infiltration provides an efficient and reproducible technique for the Achilles tendon repair. It avoids the need for a pneumatic tourniquet and limits the risk of peripheral nerve block failure.
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NewsBot · Jul 2, 2026

Wide-Awake Local Anesthesia No Tourniquet (WALANT) for elective forefoot surgery: Prospective case series of 30 patients describing protocol, analgesic efficacy, and PROM’s results
Manel Ballester et al
Source

Background: Wide-Awake Local Anesthesia No Tourniquet (WALANT) is a relatively new anesthetic technique for elective forefoot surgery that avoids general or neuraxial anesthesia, popliteal nerve blocks, and tourniquet use while allowing active intraoperative patient participation. Originally developed for hand surgery, its application to forefoot procedures remains insufficiently characterized.
Methods: We conducted a single-center prospective case series of 30 consecutive adult patients undergoing elective forefoot surgery under a standardized WALANT protocol. The anesthetic solution consisted of subcutaneous 1% lidocaine with epinephrine 1:200,000. Primary outcomes were intraoperative and postoperative pain measured using the Numeric Rating Scale (NRS 0–10) at four timepoints, and patient satisfaction across seven domains using a 5-point Likert scale. Secondary outcomes included operative time and safety profile within 48 hours.
Results: Mean age was 65.2 ± 9.7 years; 80% of patients were female. Indications included hallux valgus (56.7%), hallux rigidus (16.7%), hallux valgus with metatarsalgia (13.3%), and isolated metatarsalgia (13.3%). Mean operative time was 32.3 ± 9.4 minutes. Mean intraoperative NRS was 0.17 ± 0.38, increasing to 0.23 ± 0.50 at immediate recovery, 1.47 ± 2.01 at 6 hours, and 1.97 ± 1.90 at 24 hours. No intraoperative complications occurred, and no case required conversion to regional or general anesthesia. Minimal pain during surgery (agree/strongly agree) was reported by 96.7% of patients, and overall surgical experience was rated positively by 83.3%. Nine patients (30%) presented with mild postoperative wound oozing requiring dressing reinforcement or change; no hematomas, infections, neurovascular injuries, or reoperations were observed.
Conclusion: WALANT is a safe, effective, and well-tolerated anesthetic strategy for elective forefoot surgery, providing near-complete intraoperative analgesia and high patient satisfaction without the need for tourniquet or regional block. Mild postoperative wound oozing appears to be an expected effect of tourniquet-free surgery and should be regarded as a manageable, anticipated event rather than a true surgical complication, provided appropriate patient education is delivered.
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NewsBot · Jul 19, 2026

Randomized Prospective Study Comparing Wide-Awake Local Anesthesia No Tourniquet (WALANT) and Locoregional Anesthesia in Minimally Invasive Hallux Valgus Surgery: Preliminary Results
Daniele Marcolli et al
Foot Ankle Orthop. 2026 Jul 16;11(3):24730114261455303.

Background: Minimally invasive techniques for hallux valgus correction, such as minimally invasive chevron Akin (MICA), are increasingly adopted and traditionally performed under locoregional anesthesia (LRA). The choice of anesthetic technique may influence perioperative outcomes, patient experience, and resource utilization. The Wide-Awake Local Anesthesia No Tourniquet (WALANT) technique has recently been introduced in foot surgery as a potential alternative.

Methods: A prospective, randomized, single-center study was conducted on 40 patients with mild to moderate hallux valgus undergoing correction with the MICA technique. Patients were randomized into 2 groups: LRA (n = 20) and WALANT (n = 20). The primary endpoint of this study was the assessment and comparison of intraoperative and postoperative pain at 24 hours between the WALANT and LRA groups. Secondary endpoint was the comparison of anesthetic time and recovery stay between the 2 techniques.

Results: Mean intraoperative and postoperative NRS pain scores showed no statistically significant differences between the 2 groups. The anesthesia time and the recovery stay were significantly shorter in the WALANT group compared with the LRA group. All WALANT procedures were successfully completed without anesthetic conversion.

Discussion: The application of WALANT in hallux valgus surgery meets the growing demand for efficient perioperative pathways, potentially improving operating room efficiency and reducing hospitalization time. In this preliminary study, no statistically significant difference in intraoperative or postoperative pain at 24 hours was detected between WALANT and LRA with the numbers available. These findings suggest that WALANT may represent a feasible anesthetic approach for MICA correction of hallux valgus.

Conclusion: In this prospective randomized study, no statistically significant difference in intraoperative or postoperative pain was detected between WALANT and locoregional anesthesia with the numbers available. WALANT was associated with shorter anesthesia time and recovery stay, suggesting that it may represent a feasible anesthetic option for MICA hallux valgus surgery. Further studies with larger cohorts are required to confirm these findings.
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Wide-Awake Foot and Ankle Surgery

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Wide-Awake Foot and Ankle Surgery

NewsBot The Admin that posts the news.

Admin2 Administrator Staff Member

bob Active Member

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

World wide trends in diabetic foot ulcers

Hoka Clifton 3 is wider

French podiatrist looking for a sponsorship Australia wide

PODIATRIST - WANTED UK WIDE

PODIATRIST - WANTED UK WIDE

Podiatry Jobs Available - UK wide

Locum Podiatry - Australia wide, 2015

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