60 severely and morbidly obese patients scheduled for unilateral foot or ankle surgery were randomized to an ultrasound-guided popliteal sciatic nerve blockade either proximal or distal to the branching point of the sciatic nerve. The purpose of this study was to compare the two block administration sites in terms of pain scores, block onset characteristics, and complications. Outcomes were assessed perioperatively and at 1-week postoperative to determine patient satisfaction. Findings indicated significantly less pain, faster block onset, and fewer incidences of conversion to general anesthesia in the distal group compared to the proximal group upon entering the post-anesthesia care unit. Block procedure times, the incidence of nerve injury, and patient satisfaction were comparable between groups.