Toes, Foot, Ankle and Calcaneus

Question 1

Toes - AP Axial Projection

Answer 1

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

Question 2

Toes - AP Axial Evaluation Criteria

Answer 2

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

Question 3

Toes - AP Oblique Projection

Answer 3

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

Question 4

Toes - AP Oblique Evaluation Criteria

Answer 4

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

Question 5

Toes - Lateral Projection

Answer 5

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

Question 6

Toe - Lateral Evaluation Criteria

Answer 6

tip of toe to distal metatarsal
entire toe with minimal superimposition
true lateral
- toenail in profile
- concave plantar surface
open joint spaces

Question 7

what are the 3 common fractures of the foot?

Answer 7

Base of the 5th metatarsal
March fracture - stress fracture of 2-4 metatarsal
Lisfranc joint separation - separation of mid foot MTP joints

Question 8

What is exostosis?

Answer 8

bone spurs
- benign bony outcropping

Question 9

What is hallux valgus?

Answer 9

bunions
- great toe bent away from midline

Question 10

What is pes planus?

Answer 10

flatfoot
- collapsed arch of foot

Question 11

Foot - AP Axial Projection

Answer 11

Same position as toes
CR: 10-15 cephalad - perpendicular to metatarsals
CP: base of third metatarsal
may see wedge filter used

Question 12

Foot - AP Axial Evaluation Criteria

Answer 12

entire foot visualized
no rotation
- equal space between 2-4 metatarsals
IP, MTP, TMT joints demonstrated
phalanges not burned out

Question 13

Foot - AP Oblique

Answer 13

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

Question 14

Foot - AP Oblique Evaluation Criteria

Answer 14

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

Question 15

Foot - Lateral (mediolateral) projection

Answer 15

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

Question 16

Foot - Lateral (Mediolateral) Evaluation Criteria

Answer 16

entire foot and distal tibia/fib
superimposed plantar surface of metatarsal heads
fibula overlaps posterior portion of tibia
tibiotalar joint

Question 17

Foot - Standing Lateral (lateromedial) projection

Answer 17

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

Question 18

Foot - AP Axial Weight Bearing Projection

Answer 18

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

Question 19

Foot - AP Axial Weight Bearing Evaluation Criteria

Answer 19

Both feet on one image
both markers and weight bearing marker

Question 20

Calcaneus - Axial projection

Answer 20

inferosuperior/plantodorsal
90 degree dorsiflexion
- may need band
CR: 40 cephalad
CP: base of 3rd metatarsal
may use wedge

Question 21

Calcaneus - Axial Evaluation Criteria

Answer 21

All of calcaneus and talocalcaneal joint
No rotation

Question 22

Calcaneus - Lateral projection

Answer 22

same as lateral foot
similar collimation
CP: 1” inferior to medial malleolus

Question 23

Calcaneus - Lateral Evaluation Criteria

Answer 23

Entire calcaneus, ankle joint and surrounding tarsals
no rotation
- tuberosity in profile
- sinus tarsi open
- calcaneocuboid and talonavicular joints open

Question 24

Ankle - AP Projection

Answer 24

dorsiflex foot
palpate malleoli
- lateral should be closer to IR
CR: perpendicular
CP: between malleoli

Question 25

Ankle - AP Evaluation Criteria

Answer 25

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

Question 26

Ankle - Lateral Projection

Answer 26

mediolateral
same as foot
CR: perpendicular
CP: medial malleolus

Question 27

Ankle - Lateral Evaluation Criteria

Answer 27

Distal leg, talus, calcaneus and adjacent tarsals
True lateral
- tibiotalar joint visualized
- talar domes superimposed
- fibula over posterior 1/3rd of tibia

Question 28

Ankle - AP Oblique “Mortise View” Projection

Answer 28

Dorsiflex foot
15-20 medial rotation from AP
- malleoli equidistant to IR
CR: perpendicular
CP: between malleoli

Question 29

Ankle - AP Oblique “Mortise View” Evaluation Criteria

Answer 29

open mortise joint

Question 30

Ankle - Stress View (Not on Practical Exam)

Answer 30

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