TOES

Projection: DORSIPLANTAR (AP)

Centring Point: To the third metatarsophalangeal joint

Projection: DORSIPLANTAR (AP OBLIQUE)

Centring Point: To the third metatarsophalangeal joint

Points to consider

Technique

Always include the phalanges and distal metatarsals

Care with exposure – overpenetration of distal phalanges

Try using an aluminium filter for the optimal exposure

For the great toe – centre to proximal interphalangeal joint

Radiological assessment

Freiburg’s infarction – osteochondritis of the second metatarsal head

Osteomyelitis – soft tissue swelling and irregular depleted bone

Trabeculae should be uniform or change gradually

Extensive soft tissue swelling – severe injury or bone infection

Phalanges and metatarsals of each toe should lie straight

Dorsiplantar (AP)

• Patient sitting with hips and knees flexed

• Affected foot is placed with the plantar aspect upon the cassette

Collimation

To include: PROXIMALLY: Metatarsals

DISTALLY: Phalanges

LATERALLY: Soft tissue borders

MEDIALLY: Soft tissue borders

Dorsiplantar (AP oblique)

• Patient sitting with hips and knees flexed

• Affected foot is placed with the plantar aspect upon the cassette

• Leg is medially rotated so that the foot is at an angle of approximately 30–40° to the cassette

• Non-opaque pad used if necessary

Collimation

To include: PROXIMALLY: Metatarsals

DISTALLY: Phalanges

LATERALLY: Soft tissue borders

MEDIALLY: Soft tissue borders

TOES

Projection: LATERAL

Centring Point: To the first metatarsophalangeal joint

Points to consider

Technique

True lateral – limited value as the toes are superimposed

To isolate a specific toe – use a non-opaque pad

Do not forcibly separate the toes – exacerbates injury

Slightly flex the knee to aid positioning and comfort

Try raising the cassette upon a pad before positioning

Radiological assessment

Sesamoid bones of the great toe arise from two or more centres

Failure to unite – may resemble an epiphyseal #

Trabeculae should be uniform or change gradually

Projection has limited value apart from assessing the extent of any displacement

Lateral

• Patient lies:

– For the first, second and third toes – on the side opposite to that being examined

– Medial side of the foot and leg under examination is placed in contact with the table top

– For the fourth and fifth toes – on the side under examination

– Lateral side of the foot and leg under examination is placed in contact with the table top

• Plantar aspect of the foot is at right angles to the cassette

• A pad is placed under the ankle to maintain the position

Collimation

To include: PROXIMALLY: Metatarsals

DISTALLY: Phalanges

LATERALLY: Soft tissue borders

MEDIALLY: Soft tissue borders

FOOT

Projection: DORSIPLANTAR (AP)

Centring Point: To the cuboid–navicular joint, 10° cephalic angulation to demonstrate tarsal bones

Projection: DORSIPLANTAR (AP OBLIQUE)

Centring Point: To the cuboid–navicular joint

Points to consider

Technique

Slight angulation of tube towards the ankle – this will open the articulations of the foot

Oblique – metatarsals free from superimposition

Consider using a wedge filter for optimum penetration

Ensure knee is flexed to prevent the cassette from slipping

Radiological assessment

Lisfranc injury – # through base of second metatarsal and dislocation of third, fourth and fifth metatarsals

Accessory ossification centre – base of fifth metatarsal – bone contours smooth and rounded with intact cortical margins

Look for periosteal thickening – stress #

Oblique – consider the anterior calcaneum for avulsion #s

Dorsiplantar (AP)

• Patient sitting with hips and knees flexed

• Affected foot is placed with the plantar aspect upon the cassette

• Leg can be supported by the opposite leg

Collimation

To include: PROXIMALLY: Head of talus

DISTALLY: Great toe

LATERALLY: Soft tissue borders

MEDIALLY: Soft tissue borders

Dorsiplantar (AP oblique)

• Patient sitting with hips and knees flexed

• Affected foot is placed with the plantar aspect upon the cassette

• Leg is medially rotated so that the foot is at an angle of approximately 30–40° to the cassette

• Non-opaque pad is placed under the foot

Collimation

To include: PROXIMALLY: Head of talus

DISTALLY: Great toe

LATERALLY: Soft tissue borders

MEDIALLY: Soft tissue borders

FOOT

Projection: LATERAL

Centring Point: To the navicular–cuneiform joint

Points to consider

Technique

This projection is used when a foreign body is suspected or an additional projection for # or dislocation

Lateral projection must include the whole of calcaneum

Do not overpenetrate the calcaneum

Place a pad under the knee to maintain the position

Radiological assessment

Check the alignment of the talonavicular and calcaneocuboid bones

Look for breaks in the cortical bone or bony trabeculae

Soft tissue overlying the calcaneum should be seen

Possible # of calcaneum – consider Bohler’s (see calcaneum)

Lateral

• Patient lies on the affected side

• Hips and knees are flexed

• Knee is supported so that the plantar aspect of the foot is at right angles to the cassette

Collimation

To include: PROXIMALLY: Calcaneum

DISTALLY: Great toe

LATERALLY: Soft tissue borders

ANKLE JOINT

Projection: AP

Centring Point: Midway between the malleoli

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Radiology Key

Fastest Radiology Insight Engine

Lower Extremity

TOES

Points to consider

Technique

Radiological assessment

Dorsiplantar (AP)

Collimation

Dorsiplantar (AP oblique)

Collimation

TOES

Points to consider

Technique

Radiological assessment

Lateral

Collimation

FOOT

Points to consider

Technique

Radiological assessment

Dorsiplantar (AP)

Collimation

Dorsiplantar (AP oblique)

Collimation

FOOT

Points to consider

Technique

Radiological assessment

Lateral

Collimation

ANKLE JOINT

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Lower Extremity

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