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Peripheral nerve blocks at the ankle have long been used for foot surgery. However, when local foot and ankle blocks are inappropriate or contraindicated, general and spinal anesthesia are the common alternatives. Both have disadvantages and require added equipment and monitors. Combined popliteal and saphenous nerve blocks at the knee can offer a desirable alternative to general and spinal anesthesia for foot and ankle surgery. In addition, popliteal and saphenous nerve blocks provide anesthesia of the entire lower leg, thus permitting a greater variety of procedures to be performed. This article reviews the anatomical considerations, various block techniques, and surgical applications of this useful approach to lower-leg anesthesia.