Seven randomized controlled trials comprising of 483 adult patients undergoing foot or ankle surgery with ultrasound-guided popliteal sciatic nerve block were reviewed in this meta-analysis. Trials compared subsheath (intraneural/subparaneural) injection with extraneural injection, most commonly performed at the sciatic nerve bifurcation. The primary outcome was block success within 30 minutes, with secondary outcomes including performance time, onset time, duration of sensory block, and complication rates. Fixed-effects models were used due to low heterogeneity for most outcomes. Overall, the results demonstrated that subsheath injection significantly improved block success, shortened onset and performance time, and prolonged sensory block duration, without increasing complication rates. These findings support subsheath injection as a more efficient and equally safe approach for popliteal sciatic nerve block in foot surgery.