Toes, Foot, and Ankle Flashcards by Melissa Unknown

What is toe rotation controlled by?

Your foot

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How is the concavity of the midshaft of the proximal phalanx

Concavity of the midshaft of the proximal phalanx is equal on both sides

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What term means the bottom of your foot

Plantar

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What term means the top of the foot

Dorsum

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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

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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

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What do you do if the patient can’t get their toes flat ?

Angle cephalically

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What should be in profile in the lateral toe?

Toe nail should be in profile

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What would rotate in the same direction as the foot

The toenail

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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

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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

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How much do you rotate the foot for an AP oblique toes

Rotate the foot 45 degrees

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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

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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

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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

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For a lateral toe, which aspect has more concavity

The posterior aspect shows more concavity

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What is the degree for an AP foot dorsaplantar

Zero degrees

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How the condyles in a lateral toe

Condyles are superimposed

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What is in profile in a lateral toe

Toenail

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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

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Main issue for an AP foot

Getting Uniform density - more density up through the cuboids and the toes are much thinner

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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

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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

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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

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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 openDistal 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 domeFibula 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