Toes, Foot, Ankle and Calcaneus Flashcards
Toes - AP Axial Projection
AKA dorsiplantar
Plantar surface on the IR
- knee flexed
- may need to immobilize the IR
Separate toes if needed
CR: 10-15 cephalad
CP: 3rd MTP for all toes
collimate to include small portion of digit on either side for single toes
Toes - AP Axial Evaluation Criteria
Tip of toe to distal half of metatarsal
Toes separated from each other
no rotation of phalanges
- equal soft tissue and concavity
open joint spaces
Toes - AP Oblique Projection
medial rotation of foot
CAN use lateral rotation for 4th and 5th (don’t do this at Fanshawe)
CR: perpendicular
CP: 3rd MTP for all toes of MTP of individual toe
Include one digit on either side of individual toes
Toes - AP Oblique Evaluation Criteria
Tip of toes of mid distal metatarsal
toes seperated
more soft tissue and concavity on elevated side (lateral)
Open IP joints
Open MTP joints 2-5
Toes - Lateral Projection
1st digit: lateromedial (marker face down)
2nd-5th digit: mediolateral
separate affected toe
- tape, band or tongue depressor
true lateral, no distortion
- may need to elevate heel
Toe - Lateral Evaluation Criteria
tip of toe to distal metatarsal
entire toe with minimal superimposition
true lateral
- toenail in profile
- concave plantar surface
open joint spaces
what are the 3 common fractures of the foot?
Base of the 5th metatarsal
March fracture - stress fracture of 2-4 metatarsal
Lisfranc joint separation - separation of mid foot MTP joints
What is exostosis?
bone spurs
- benign bony outcropping
What is hallux valgus?
bunions
- great toe bent away from midline
What is pes planus?
flatfoot
- collapsed arch of foot
Foot - AP Axial Projection
Same position as toes
CR: 10-15 cephalad - perpendicular to metatarsals
CP: base of third metatarsal
may see wedge filter used
Foot - AP Axial Evaluation Criteria
entire foot visualized
no rotation
- equal space between 2-4 metatarsals
IP, MTP, TMT joints demonstrated
phalanges not burned out
Foot - AP Oblique
position if AP then rotate medially
- 30 for medial portion
- 45 for lateral portion (always use 45 at Fanshawe)
CR: perpendicular
CP: base of 3rd MT
may use filter
Foot - AP Oblique Evaluation Criteria
entire foot
3-5 metatarsals free of superimposition
base of 1-2 superimposed with the cuneiforms
cuboid free of superimposition
base of 5th MT
Sinus tarsi
Foot - Lateral (mediolateral) projection
lie on affected side
- other leg behind
- ensure calcaneus is parallel to IR
- foot dorsiflexed to 90
CR: Perpendicular
CP: Around medial cuneiform
Include dital tib/fib
Foot - Lateral (Mediolateral) Evaluation Criteria
entire foot and distal tibia/fib
superimposed plantar surface of metatarsal heads
fibula overlaps posterior portion of tibia
tibiotalar joint
Foot - Standing Lateral (lateromedial) projection
bring heel out a bit
CR: perpendicular
CP: mid foot around base of 3rd
Marker for side and arrow up to indicate standing - face down
unilateral for practical but usually do bilateral
Foot - AP Axial Weight Bearing Projection
Use grey CR cassette
SID: 102-120 (as close to 102 as you can)
CR: 15 towards heel
CP: base of 3rd between feet
both markers and arrow
may use filter
Foot - AP Axial Weight Bearing Evaluation Criteria
Both feet on one image
both markers and weight bearing marker
Calcaneus - Axial projection
inferosuperior/plantodorsal
90 degree dorsiflexion
- may need band
CR: 40 cephalad
CP: base of 3rd metatarsal
may use wedge
Calcaneus - Axial Evaluation Criteria
All of calcaneus and talocalcaneal joint
No rotation
Calcaneus - Lateral projection
same as lateral foot
similar collimation
CP: 1” inferior to medial malleolus
Calcaneus - Lateral Evaluation Criteria
Entire calcaneus, ankle joint and surrounding tarsals
no rotation
- tuberosity in profile
- sinus tarsi open
- calcaneocuboid and talonavicular joints open
Ankle - AP Projection
dorsiflex foot
palpate malleoli
- lateral should be closer to IR
CR: perpendicular
CP: between malleoli
Ankle - AP Evaluation Criteria
Entire ankle joint, distal leg and proximal talus
Inferior tibiofibular and talofibular articulations NOT open
No rotation
- overlap of tibiofibular articulation
- talus slightly overlapping distal fibula
- open medial tallomalleolar articulation
Ankle - Lateral Projection
mediolateral
same as foot
CR: perpendicular
CP: medial malleolus
Ankle - Lateral Evaluation Criteria
Distal leg, talus, calcaneus and adjacent tarsals
True lateral
- tibiotalar joint visualized
- talar domes superimposed
- fibula over posterior 1/3rd of tibia
Ankle - AP Oblique “Mortise View” Projection
Dorsiflex foot
15-20 medial rotation from AP
- malleoli equidistant to IR
CR: perpendicular
CP: between malleoli
Ankle - AP Oblique “Mortise View” Evaluation Criteria
open mortise joint
Ankle - Stress View (Not on Practical Exam)
demonstrates ligament or tendon damage
true AP position
- foot in as much dorsiflexion as possible
Forced inversion/enversion
- done by radiologist or orthopaedic surgeon
- use lead gloves
