Surgery of the distal lower extremities offers unique opportunities for regional anesthesia. Many procedures can be accomplished with peripheral nerve block (PNB) and sedation alone, whereas others may require general anesthesia; in the absence of contraindications, PNB should be considered for all patients, keeping in mind contraindications, discussed below. This approach can provide excellent intraoperative anesthesia and postoperative analgesia. In addition, neuraxial anesthesia may be used in procedures of the lower extremities.