Ankle blocks are routinely indicated for surgical anesthesia and postoperative analgesia of procedures involving the foot. Traditionally, ankle blocks have been performed by relying on landmark identification of nerves. The literature regarding the performance and efficacy of ankle blocks is inconsistent. This can be attributed to several variables, such as provider technique, differences in patient populations, and the type and volume of local anesthetics administered. As with other peripheral nerve blocks originally performed using landmark technique, ultrasound imaging is now being incorporated into these procedures. Ultrasound guidance provides the anesthetist with several advantages over landmark techniques. The ability to identify peripheral nerves, view needle movements in real-time, and observe the spread of local anesthetic has been shown to result in greater block efficacy, even with reduced volumes of local anesthetic. Additionally, ultrasound imaging gives the provider the option to perform regional anesthesia in specific patient populations not considered possible when using landmark technique. Despite the limited literature on ultrasound-guided ankle blocks, outcome metrics seem to be consistent with those of other peripheral nerve blocks performed using this technology.