procedures: toes, foot, ankle, heel

notes

10x12 light field

table top

40 in SID

AP/ DP toe positioning

pt in supine position with knee flexed

plantar surface flat on IR

DP

dorsal planter

AP/DP CR

10-15 degrees cephalad angle to MTP joint of interest

(aurora 15 degrees)

option: use sponge for angle then had perpendicular IR

AP/DP toe demonstrates

digit of interest and half of metatarsal

-aurora include to TMT joint

open interphalangeal joint and MTP joint

no rotation/ equal concavity

AP/DP toe marker and orientation

since collimation is tight just get the right and left in

annotate what digit

AP/DP oblique toe positioning

-supine position, knee flexed, plantar surface on IR

-rotate foot and leg 30-45 degrees medial or lateral

do AP/ DP medial oblique when doing

digits 1, 2, and 3

do AP/DP lateral oblique when doing

4th and 5th digit

degree of obliquity for medial vs lateral

medial = 30-40 degrees oblique

lateral oblique = 30 degrees

AP/ DP oblique toes CR

perpendicular to MTP joint of interest

AP/DP oblique film eval

-digit of interest and half of MT

(aurora includes TMT if pain in the general entire area)

-open interphalangeal and MTP joint

-more concavity on one side

lateral toe positioning

-pt lying recumbent

-place either the medial or lateral surface to IR

-separate toe of interest

lateral toe positioning for medial vs lateral

medial surface down for 1st, 2nd, 3rd digit

lateral surface down for 4th or 5th digit (sometimes can do 3rd digit lateral)

lateral toe CR

1st toe perpendicular to IP joint

2nd-5th toe perpendicular to PIP joint

lateral toe film eval

-lateral view of phalanges and IR and MTP joints open

-free of other toes

-half of MT/ aurora to MTP joint

-no concavity on one side

sesamoid bone... tangential projection

positioning, prone

dorsiflex foot to form 15-20 degree angle from vertical, dorsiflex great toe

-decreases OID

sesamoid bone... tangential projection

positioning, supine

leg extended, dorsiflex foot

hyperflex toes

increased OID

sesamoid bone... tangential projection

CR

perpendicular to IR

tangential to first MTP joint

sesamoid bone demonstrates

sesamoids in profile free of superimposition

AP/DP foot position

supine, flex knee, plantar surface flat on IR

AP/DP foot CR

10 degrees cephalad, entering at the base of the third MT

-reduces foreshortening of MTs and opens MTP joints

-include from toes thru calcaneus

AP/DP foot demonstrates

phalanges through talus

no rotation- equal concavity

AP/DP foot marker and orientation

mark lateral

orientation: as if you put your foot up there

oblique foot position

-supine, flex knee, plantar surface flat on cassette

-medial oblique

-dorsal surface should be parallel to IR and perpendicular to CR

oblique foot position- medial oblique

rotate leg medially 30-40 degrees

(high arched foot, more angle/ closer to the 40 degrees)

difference between AP and oblique

make sure to take the angle off the tube when going from AP to oblique

medial oblique foot demonstrates

-lateral side

-open joint spaces around the cuboid

-3rd through 5th metatarsals free of superimposition

-1st and 2nd MT's slightly superimposed

-sinus tarsi open

-tuberosity of 5th metatarsal

what is the most common fx metatarsal

5th MT

what is the best view to see the sinus tarsi

medial oblique foot

open joints around the cuboid in the medial oblique

cuboid and 4th and 5th metatarsals

cuboid and 3rd cuneiform

cuboid and calcaneus

medial oblique marker

lateral

jones fx

fx of base of the 5th metatarsal

horizontal fx

dancers fx

avulsion fx of 5th MT/ tuberosity

lateral oblique foot

rotate leg laterally 30 degrees

lateral oblique foot demonstrates the

medial side

navicular

-interspaces between 1st and 2nd MT's

-1st and 2nd cuneiforms

lateral foot position

-supine, flex knee, drop leg to affected side

-mediolateral projection

-turn to affected side, lateral surface against IR

-dorsiflex foot (90 degrees to LL)

-plantar surface perpendicular to IR

lateral foot CR

perpendicular to the medial cuneiform at the level of the base of the third metatarsal/medial cuneiform

according to the book the ______ projection is a more true lateral

lateromedial

lateral foot demonstrates

tibiotalar joint is open

includes 1-2 in of distal tibia and fibula

fibula is superimposed by posterior tibia

distal metatarsals superimposed

foot is dorsiflexed

lateral foot marker and orientation

marker anterior

orientation: like they are standing in front of you

lateromedial lateral foot

considered the "true lateral"

-turn onto unaffected side, medial side of foot against IR, dorsiflex foot, plantar surface perpendicular to IR

con to laterolmedial projection for the lateral foot

can be too uncomfortable/ painful

AP ankle positioning

leg extended

toes up

no rotation of the leg

AP ankle CR

perpendicular to midway between malleoli (ankle jt)

-want 1/3 of lower leg included

AP ankle demonstrates

-ankle joint

-distal lower leg

-upper portion of talus

-distal fibula overlapped on the tibia and talus

-tibiotalar joint space

AP ankle marker and orientation

-mark lateral

-orientation like pt is standing in front of you

AP mortise

-rotate pt leg 15-20 degree medially, intermalleolar plane is parallel to IR

(auroras protocol)

-ankle joint in profile, visible on all three sides

oblique ankle

rotate leg and foot 45 degrees medially

distal tibiofibular joint

AP mortise/ oblique positioning

leg fully extended, toes up

AP mortise/ oblique CR

perpendicular between malleoli

lateral ankle position

turn pt onto affected side

mediolateral projection

dorsiflex the foot

lateral ankle CR

perpendicular at medial malleolus

lateral ankle demonstrates

-true lateral view of distal tibia, fibula, the tibiotalar joint, tarsus

-fibula should be over posterior half of tibia

-open tibiotalar joint

-evaluate fx and dislocations

-include entire heel and 5th tuberosity

lateral ankle marker and orientation

mark anterior

orientation as if they are standing in front of you

bimalleolar (potts) fx

both malleoli are fx

trimalleolar fx

medial and lateral malleoli and posterior tibia are fx

lower leg prosthetic

leave cones open a little more to include hardware

axial calcaneus

plantodorsal projection

axial calcaneus positioning

-supine with leg fully extended

-dorsiflex foot to place plantar surface perpendicular to IR

-increase angle if pt is unable to put plantar surface perpendicular

-may use device to hold foot

axial calcaneus CR

-40 degrees cephalad

-entering plantar surface at level of base of the 3rd metatarsal

axial calcaneus demonstrates

open talocalcaneal joint

medial/lateral displacement of fractures

axial calcaneus marker and orientation

mark lateral

orientation as if they are standing in front of you

lateral calcaneus position

lateral surface of foot against IR

mediolateral projection

dorsiflex foot

lateral calcaneus film eval

open talocalcaneal jt

bone spurs (if there)

lateral calcaneus marker

anterior

exposure index

S# 150-400

EI # 200-600

toe technique

kVp = 55

mAs = .8-1

foot technique

kVp = 60

mAs Ap/ obl = 1.2-1.6

mAs lat = 2-2.5

ankle technique

kVp = 60

mAs = 2-2.5

heel technique

kVp = 60

mAs tangential = 4-5

mAs lateral = 2.5

for foot and ankle if the pt can stand, do

all three views standing

AP foot- weight bearing

make sure weight is equally distributed

increase angle from 10 to 15 degrees

center at base of thrid MT

annotation

make sure to mark if it was done standing

medial oblique foot- weight bearing

foot stays AP we just add angle

40-45 degree angle (typically 45)

center at base of thrid MT

supine vs standing medial oblique

some distortion when standing due to angle

lateral weight bearing foot

make sure weight is distributed equally

pt position: erect on a rise device

lateromedial projection

lateral weight bearing foot CR

base of third MT

collimation: make sure to have 2 in of distal tib fib on image

lateral weight bearing foot is done to evaluate

longitudinal arch

lateral weight bearing foot demonstrates

lateral view of bones in wight bering position

structural status of longitudinal arch

all standing views of the ankles are done on the

stairs

CR for lateral standing ankle

at medial malleoli, but since we are lateral the medial malleoli will be against the IR so you feel for the lateral malleoli and center 1 in above

weight bearing axial heel CR

exit base of 3rd MTP

dorsoplantar for upright as opposed to platnardorsal for supine

weight bearing heel angle difference

angle is increased for 40 to 45 degrees

weight bering heel lateral CR

perpendicular to lateral malleoli (which is 1 in below the medial malleoli

ankle stress view: pt positioning

-leg fully extended

-dorsiflex foot

-plantar surface turned medially for inversion and laterally for eversion

ankle stress view demonstrates

tear/ rupture of ligament by widening ofjoint space of affected side