15 standard views of the foot and ankle
Many are taken *weight bearing
An anterior posterior (AP) projection goes through the foot from anterior (dorsal) to posterior (plantar)
An AP view is obtained from an AP projection, for example.
Often the term “view” is used to describe both position and projection.
Area visualized: distal to the midtarsal joint
Can be difficult to see tarsal-metatarsal area secondary to bony overlap
Aim central ray at *base of second metatarsal
What’s wrong in the photo?
Aim central ray 15 degrees cephalid.
Exceptions
NWB exam
AP of a toe
Use the angular indicator on the X-Cel to keep the central ray at 15 degrees.
Exceptions
NWB exam
AP of a toe
Difficult to view intermediate, lateral cuneiform and toes.
Medial side of foot is against the cassette
Exception: NWB*
Angle and base of gait
Central ray at 90* degrees to the film
Aim at midfoot*
locate a retained foreign body
when the patient is unable to bear weight (post op, fracture, etc.)
Lateral side of foot against the cassette
Position like a lateral
Elevate the digit with a plastic or wood block
Raised Hallux lateral
plantar calcaneus, cuboid
lateral cuneiform, metatarsals
lateral aspect of navicular,
digits
Central ray is *perpendicular to cassette
Patient tilts (everts) foot 45 degrees
30 degrees (lat cune)
60 degrees (cuboid)
Partial weight bearing
Not in angle or base of gait
*medial structures,
including 1st met, navicular, medial
Lateral side of foot against the cassette
Invert foot 45 degrees
Central ray is *perpendicular to cassette.
Not in angle or base of gait
sesamoids, sesamoid/1st met articulations
lesser met heads
Film perpendicular to the floor
Central ray aimed posterior and inferior to the calcaneus
Central ray is also perpendicular to cassette
X-ray table, toes dorsiflexed with a strip of gauze
Central beam at 0 degrees
Lewis method
Toes dorsiflexed against cassette
Central beam at 0 degrees
X-ray table, toes dorsiflexed with a strip of gauze
Central beam at 0 degrees
Lewis method
Toes dorsiflexed against cassette
Central beam at 0 degrees
body of calcaneus
posterior and middle facets of the STJ
sustentaculum tali
Technically, posterior tangential projection modification
Central beam at 45 degrees
Not in angle or base of gait
ankle mortise, except lateral gutter.
Talar body
distal tibia
fibula
Heel against plate, foot straight ahead (angle of gait)
Central beam from anterior, *aimed between the malleoli
Internally rotate leg about 15 degrees so that the malleoli are parallel with the plate.
Central ray from anterior
distal tibia
talus
Calcaneus
ankle joint
Navicular
cuboid
Medial side of foot against cassette
Aim central ray at the lateral malleolus
Stress Lateral View
Position patient as a routine lateral, but have them flex knee and dorsiflex the ankle
Stress Lateral Position
Anterior Drawer Stress View
Lateral malleolus on cassette, which is vertical
Wear lead gloves or use a Telos device
Lead gloves or Telos device
Maximally invert the STJ
don’t take
–Steven Palladino, D.P.M.