Wide-Awake No Tourniquet Technique in Foot And Ankle Surgery: A Case Series Study

Background: The Wide-Awake Local Anesthesia No Tourniquet (WALANT) technique is well established in hand surgery; however, evidence supporting its use in foot and ankle surgery remains limited. Purpose: To evaluate the safety, analgesic profile, early complications, and patient acceptance of WALANT in a heterogeneous cohort of foot and ankle procedures performed in a secondary-care hospital. Methods: This single-center retrospective cohort study included consecutive patients who underwent forefoot, hindfoot, or lower-leg procedures under WALANT between 2019 and 2023. Patients receiving concomitant anesthesia, tourniquet use, lacking written informed consent, or with incomplete data were excluded. Demographic data, anesthesia details, surgical outcomes, complications, and patient-reported experience were collected from institutional records and supplemented by standardized telephone interviews. Pain was assessed using the Visual Analogue Scale (VAS) during anesthetic infiltration, intraoperatively, and within 48 hours postoperatively. Unplanned emergency department visits, clinic reviews, and hospital readmissions within a 6-week follow-up period were recorded. Descriptive statistics were used. Results: Forty-three patients were included (28 women; mean age 56.9 ± 12.5 years). Mean VAS scores were 3.5 ± 2.2 during anesthetic injection, 0.7 ± 1.5 intraoperatively, and 3.2 ± 2.5 at 48 hours postoperatively. Mean operative time was 51.1 ± 27.1 minutes. Supplemental local anesthetic was required in 7 patients (16.3%); no cases required conversion or escalation of anesthesia. Six patients (14.0%) had unplanned emergency department visits or admissions within 6 weeks. Four patients (9.3%) developed wound infections, three treated with oral antibiotics and one requiring short hospital admission for intravenous antibiotics; no reoperations were necessary. Overall, 41 patients (95%) reported they would choose WALANT again. Conclusion: In this secondary-care cohort, WALANT provided excellent intraoperative analgesia, acceptable early postoperative pain control, low short-term complication rates, and very high patient acceptance. Given the small, heterogeneous, and non-comparative nature of the cohort, prospective comparative studies - particularly in forefoot surgery - are warranted to compare WALANT with local nerve block and tourniquet use.