WEEK 8 - Toes, Feet, Calcaneus

Toes - Structures Included

phalanges - ½ dist. MT

AP Toe - CR

• perpen

• 15 degrees ceph (if joint spaces are of concern and toes are curled)

AP and OBL Toe - CP

• MTP Joint (single)

• 3rd MTP Joint (all toes)

AP Toes - Rotation

equal concavity

AP and OBL Toes - E/D

open joints

• IPs

• MTP

Toes - Digit Sep

toes all sep no ST overlap (minimal to none)

AP OBL and LAT Toe - CR

perpen

AP OBL Toe - Rotation

plantar surface more concave and dorsal surface almost straight

• ST 2:1

LAT Toe - CP

• digit 1: MTP

• digit 2-5: PIP

LAT Toe - Rotation

• concave plantar, straight dorsal

• condyles SI ant/post

LAT Toe - E/D

• open IPs, MTP

• condyles SI prox/dist

AP AXIAL Foot - Structures Included

phalanges - distal tal/calc

AP AXIAL Foot - CR

• perpen to LA of 3rd MTP

• 10-15 degrees ceph

Foot - CP

base of 3rd MT

AP AXIAL Foot - BTP

open joints

• TMT joints

• navicular-cuneiform joints

excessive angle

• MTs elongated

insufficient angle

• MTs foreshortened

AP AXIAL Foot - Rotation

MAIN GOAL:

• open med-mid cuneiform joint

• 1/3 talus head free of SI

SUPPORTING

• open IMT joint 1-2 free of SI

• 2-5 MT somewhat SI

• MT heads clear of SI

AP AXIAL Foot - Inversion / Lat.Rot

• more than 1/3 talus head SI by calc

• intercuneiform joint closed

• navicular tubercle comes into profile

• lots of 2-5 MT base SI

AP AXIAL Foot - Eversion / Med. Rot

• less than 1/3 SI of talar head by calc

• intercuneiform joint closed

• navicular cuneiform is more SI

• 2-5 MT bases less SI

AP OBL Foot - Structures included

phalanges - distal tib/fib (ankle joint)

AP OBL and LAT Foot - CR

perpen

AP OBL Foot - Rotation

MAIN: cuboid is free of SI on all sides

• 3-5 MT bases free of SI

• base of MT1 & MT2 SI

• equal space between MT shafts

AP OBL Foot - Insufficient OBL

• base of MT4 is SI over base of MT5 (like in AP)

• 4MT tubercle free of SI

AP OBL Foot - Excessive OBL

• closed 4-5MT joint space

• MT5 base more in profile

• MT5 is SI over the 4MT tubercle

AP OBL Foot - what is the degree of OBL dependent on

the height of the medial longitudinal arch

• higher arch = more rotation

• palpate for cuboid and ensure its // to plate

LAT Foot - Structures included

phalanges → entire ankle joint and ST (plantar**)

LAT Foot - Adequate LAT. ROT

MAIN: talar domes are aligned ant/post

• distal fib SI on post. half of tib

• MT heads SI

INT.ROT:

• ant. fib

EXT.ROT:

• post. fib

LAT Foot - No Inversion/ Eversion (knee to foot E/D)

MAIN: talar domes are aligned prox/dist

• ½ cuboid SI by navi

IV:

• ½ cuboid SI less

EV:

• ½ cuboid SI more

LAT Foot - Adequate Dorsiflexion

good 90 degrees dorsiflexion

• hyperdorsiflexion = more than 90

• hypodorsiflexion = less than 90

Relaxed LAT - Positioning

Criteria is same as LAT Foot

• 5MT free of SI from other MT due to natural inversion

• prox/dist sep of talar domes due to natural inversion

WB AP Axial Foot - Criteria

same as AP Axial Foot

WB LAT Foot - Criteria

same as LAT Foot, except:

• 5th MT tub is visualized

• may seen I/E depending on pt anatomy

• must see ant/post fat pads

LAT Calcaneus - Structures Included

• ankle joint

• talus and calcaneus

• calc-cuboid joint (adj tarsal bones)

• ST

LAT Calcaneus - CR

perpen

LAT Calcaneus - CP

mid calc (3-4cm distal to MM)

LAT Calcaneus - Criteria

same as LAT Foot

AXIAL Calcaneus - Structures Included

• entire calc

• talo-calc joint

AXIAL Calcaneus - CR

40 ceph

AXIAL Calcaneus - CP

mid calc / level of 5MT

AXIAL Calcaneus - Dorsiflexion

• open talo-calc joint

• no calc elong/foreshort

plantar flexion

• less than 40 degree tube angle

• foreshortening

hyper-dorsiflexion

• greater than 40 degree tube angle

• elongation

AXIAL Calcaneus - Alignment / Rotation

• LA of calc // LA of IR

• sustentaculum tali seen medially

EXT.ROT

• 4-5MT seen laterally

• 5MT almost free of SI

• 4MT coming into profile

INT.ROT

• 1MT seen medially

AXIAL Calcaneus - BTP

MAIN

• open talo-calc joint

• minimal elong/foreshort