Toes, Foot, and Ankle Flashcards
What is toe rotation controlled by?
Your foot
How is the concavity of the midshaft of the proximal phalanx
Concavity of the midshaft of the proximal phalanx is equal on both sides
What term means the bottom of your foot
Plantar
What term means the top of the foot
Dorsum
Does the posterior surface or the anterior surface of the proximal phalanx show more concavity than the other
Posterior surface (plantar) of proximal phalanx shows more concavity than anterior (dorsal) surface
Does the side that is being rolled away show more or less concavity
Side that’s being rolled away has more concavity and tissue seen
What do you do if the patient can’t get their toes flat ?
Angle cephalically
What should be in profile in the lateral toe?
Toe nail should be in profile
What would rotate in the same direction as the foot
The toenail
What can you look at for the rotation of the toe?
Soft tissue and concavity will be greater on the side positioned away from the side being rotated
Look at the toe nail- it will rotate is the same direction as the foot
What does a 10 to 15 degree angle do to an ap toe
IP and MTP joint spaces are open and the phalanges are demonstrated without foreshortening
How much do you rotate the foot for an AP oblique toes
Rotate the foot 45 degrees
For an AP oblique projection of the toe, which side is going to have twice as much soft tissue width and concavity
twice as much soft tissue width and concavity are present on the side of the digit rotated away from IR
For an ap oblique projection of the tow, how much soft tissue and width will be present on the side of the digit rotated away from IR
Twice as much soft tissue width and concavity
Criteria for an AP oblique projection of a toe
Rotate foot 45°
Extend toe to open joint spaces
No soft tissue or bony overlap from adjacent digits
Twice as much soft tissue width and concavity are present on the side of the digit rotated away from IR
For a lateral toe, which aspect has more concavity
The posterior aspect shows more concavity
What is the degree for an AP foot dorsaplantar
Zero degrees
How the condyles in a lateral toe
Condyles are superimposed
What is in profile in a lateral toe
Toenail
Criteria for a lateral toe
Posterior aspect shows more concavity
Condyles are superimposed
Toenail is demonstrated in profile anteriorly
No soft tissue or bony overlap
Main issue for an AP foot
Getting Uniform density - more density up through the cuboids and the toes are much thinner
Criteria for AP foot
Uniform density
Joint space of the 1st and 2ndcuneiforms are open
Concavity equal on both sides of first metararsal midshaft
TMT and navicular-cuneiform joint spaces are open
What happens when you rotate the foot laterally
The 1st and 2ndcuneiform joint space will close
Talus moves over the calcaneus ( results in less than ¾ inch of calcaneal demonstration
Increase in the metatarsal base superimposition
If you medial or laterally rotate the foot, what are you doing to the 1st and 2nd cuneiform joint space
You will close it off
What will you see in a medial rotation of the ap foot
Close joint space
Talus moves away from the calcaneus, more than ¾ inch of calcaneus is visualized
Decrease in superimposition of metatarsal bones
What spaces are closed in a medial oblique ap foot
1st and 2nd intermetatarsal joints are closed
Is the cuboid-cuneiform space open or closed in a medial oblique ap foot
Open
What spaces are open in an medial oblique ap foot
2nd - 5th intermetatarsal joint spaces are open
What is well demonstrated in a medial oblique ap foot ?
Sinus tarsi
What is the main reason for a medial oblique ap foot
For the cuboid
How many degrees should you oblique the foot for a medial oblique
30 degrees
Is the cuboid on the lateral or medial aspect
Lateral
In a medial oblique foot how is the Base of the fifth
Parallel to the ir
5th MT tuberosity is visualized
Common fracture of the base of the fifth
Jones fracture
Is the navicular on the medial or lateral aspect
Medial
what joint is open in a calcaneus projection
Talocalcaneal joint is open
how is the calcaneal tuberosity in the calcaneus projection
without distortion
how is the CR in a calcanues projection
40 degrees
parallel with the talocalcaneal joint space and
perpendicular to the calcaneal tuberosity
what is another name for the calcaneus projection
plantodorsal
what aspect of the heel is curved
medial
how should the foot be in a calcaneus projection
dorsiflexed
what are we going right through in a calcaneus projection
it is going right through the lateral malleolus so we know we are getting a good open joint space
how is the image if the foot is dorsiflexed beyond 90 degrees and the angle remains at 40 degrees
heel elongated
no longer see joint space
tuberosity is elongated
what should you do when the foot is dorsiflexed past 90 degrees
decrease the angle
what should you change if the CR remains at 40 degrees and the pt is plantar flexed
for improvement the CR should be increased to maintain accurate CR alignment
what happens when the pts foot is plantar flexed
-tuberosity foreshortened
- calcaneal joint space is obscured
how to find new angle when the pt is having a hard time dorsiflexing
Locate the base of the 5th metatarsal and the point of the fibula
Angle the CR parallel with an imaginary line drawn between them
In plantar flexion and the use of the increase angle to open the joint space, there will elongation of the calcaneal tuberosity
if the ankle is internally rotated how is the first and second metatarsals
If the ankle is internally rotated the first and second metatarsals are demonstrated medially
if the ankle is externally rotated how are the fourth and fifth metatarsals
If the ankle is externally rotated the fourth and fifth metatarsals are demonstrated laterally
which metatarsals are demonstrated medially when the ankle is interally rotated
first and second metatarsals
which metatarsals are demonstarted laterally when the ankle is externally rotated
fourth and fifth metatarsals
what joint space is open in the lateral calcaneus
Tibiotalar joint space is open
how should the foot be in a lateral calcaneus
foot is dorsiflexed
how should the tib-fib be in a lateral calcaneus
tib fib lateral position
-distal fibula is superimposed by the posterior half of the distal tibia
how are the domes in the lateral calcaneus
talar domes are superimposed
criteria for the lateral calcaneus
Tib-Fib lateral position
Talar Domes are superimposed
Tibiotalar joint space is openDistal fibula is superimposed by the posterior half of the distal tibia
Foot is dorsiflexed
Included base of the 5th
If the proximal tibia is positioned farther from the imaging table than the distal tibia, how is the lateral talar dome??
the lateral talar dome will be proximal to the medial dome
how is the tibia if the lateral talar dome is proximal to the medial dome
the proximal tibia is positioned farther from the imaging table than the distal tibia
what happens to the cuboid and navicular bone when the lateral talar dome is proximal to the medial dome
cuboid shifts anteriorly
navicular bone moves posteriorly
how is the height of the logitudinal arch when the lateral talar dome will be proximal to the medial dome
height of the longitudinal arch appears less
how is the talocalcaneal joint when the lateral dome is proximal to the medial dome ?
Talocalcaneal joint will be narrowed
If distal tibia is positioned farther from the imaging table than the proximal tibia, how is the medial talar dome?
the medial talar dome will be proximal to the lateral dome
how is the height of the longitudinal arch when the medial talar dome is proximal to the lateral dome
height of longitudinal arch appears higher than it actually is
how is the cuboid and navicular when the medial talar dome is proximal to the lateral dome
cuboid shifts posteriorly and navicular bone moves anteriorly
how is the talocalcaneal joint when the medial talar dome is proximal to the lateral dome
Talocalcaneal joint will be wider
how is the medial dome and fibula when the leg is over rotated (heel elevated)
If the leg is over rotated (heel elevated) the medial dome is
anterior to the lateral dome
Fibula is more posterior
if the medial dome is anterior to the lateral dome and the fibula is more posterior how is the leg rotated
the leg is over rotated (heel elevated)
how is the medial dome and fibula if the leg is not rotated enough (forefoot elevated)
If the leg is not rotated if enough (forefoot elevated) the medial dome is posterior to the lateral domeFibula is more anterior
if the medial dome is posterior to the lateral dome and the fibula is anterior how is the leg
leg is not rotated enough (forefoot elevated)
criteria for ap ankle
Medial mortise is open
Distal tibia and talus are superimposed over the distal fibula by 1/8th of an inch
Closing the lateral mortise
Anterior margin is approximately 1/8 inch proximal to the posterior margin
what is open in an ap ankle
medial mortise is open
what is being closed in an ap ankle
closing the lateral mortise
in an ap ankle, how much is the distal tibia and talus superimposed over the distal fibula by
1/8th of an inch
in an ap ankle, how much is the anterior margin proximal to the posterior margin
Anterior margin is approximately 1/8 inch proximal to the posterior margin
in an external rotation ap ankle , how is the tibia and talus demonstrated ?
tibia and talus demonstrate greater superimposition of the fibula and the posterior aspect of the medial malleolus
in an an internal rotation of an ap ankle, how is the fibula demonstrated ?
Internal rotation the fibula is demonstrated without talar superimposition
how is the anterior tibial margin projected when the proximal lower leg is elevated or the cr was centered proximal
anterior tibial margin is projected distally
when you elevate the proximal lower leg for an ap ankle , what does that do for the joint space
Narrows or obscured the joint space
in an ap ankle, if there is elevation of the foot what does that do to the tibiotalarjoint space
Expands tibiotalarjoint space
how is the anterior tibial margin projected when the distal lower leg is elevated or the CR was centered distally to the tibiotalar joint
the anterior tibial margin is projected more proximal to the posterior margin
what is demonstrated in an ap ankle when the foot is elevated
Demonstrating the tibial articulating surface
what is the angle of rotation for a mortise oblique of the ankle
15 to 20 degrees internally
what is in profile in an ap oblique(mortise) of the ankle
Lateral and medial malleoli are in profile
in an ap oblique(mortise) of an ankle, how is the distal fibula demonstrated?
Distal fibula is demonstrated without talar superimposition and demonstrating an open lateral mortise
how is the tibia in an ap oblique (mortise) of the ankle
tibia has slight fibular superimposition
if there is insufficient rotation in an ap oblique of an ankle (mortise) how is the medial mortise and lateral
Insufficient rotation-medial mortise will be open and the lateral will be closed
in a 45 degree oblique of an ankle how is the medial mortise and lateral mortise
medial mortise- closed
lateral mortise- partially closed
how is the fibula shown in a 45 degree oblique
fibula shown without tibial superimposition
how is the tarsi sinus in a 45 degree oblique
Tarsi sinus is shown but not clearly identifiable as an open space
how is the medial and lateral mortise if the ankle is rotated more than 45 degrees for an oblique
If the ankle is rotated more than 45°the medial and lateral mortise will be closed
how is the fibula demonstrated if there is over rotation (more than 45 degrees) for an oblique
Fibula will be demonstrated with very little if any talar superimposition
is the sinus tarsi demonstrated when there is over rotation of a 45 degree oblique ankle
Tarsi sinus will be demonstrated
how are the domes in a lateral ankle
Domes are superimposed
how is the tibiotalar joint in a lateral ankle
Tibiotalar joint is open
criteria for the lateral ankle
Domes are superimposed
Tibiotalar joint is open
Distal fibular is superimposed by the posterior half of the distal tibia
Base of the 5th MC should be included
what is the distal fibular superimposed by in a lateral ankle
Distal fibular is superimposed by the posterior half of the distal tibia
indicate joint effusion and injury
fat pads
what fat pads are in the ankle
Anterior and Posterior Pads
what fat pad is less sensitive
posterior
this fat pad is less sensitive, but requires more fluid evasion to be displaced
posterior fat pad
what flattens the anterior pad reducing its usefullness (MUST FLEX THE FOOT)
plantar flexion
what does plantar flexion do
flatten the anterior pad reducing its usefullness (must flex the foot)
In the lateral calcaneus, for the misalignment of the domes , how is the cuboid when the knee rises up
you see less of cuboid as knee rises up
in the lateral calcaneus , for the misalignment of the domes, when the distal fibia is further from the table, how is the cuboid and arch
see more of the arch and seeing more of the cuboid
what does the lateral dome follow
lateral dome follows the fibula
in a lateral calcaneus, for the misalignment of the domes, how is the cuboid when the knee rises from the table
you see less of the cuboid
in the lateral calcaneus , for the misalignment of the domes, how is the cuboid and the arch when the distal tibia rises from the table
increased arch and you see more of the cuboid
