Lower Limb: Toes, Foot, & Calcaneus

A set of flashcards summarizing essential anatomy, positioning, and technical details for imaging the toes, foot, and calcaneus.

How many bones form the entire foot and into what three groups are they divided?

26 bones: 7 tarsals, 5 metatarsals, and 14 phalanges.

How many phalanges are in each foot and how are they distributed among the toes?

1. 14 phalanges—2 in the great toe (hallux) and 3 in each of the other four toes.
2. 10 phalanges—2 in each toe.
3. 15 phalanges—3 in the great toe and 3 in each of the other four toes.
4. 12 phalanges—2 in the great toe and 2 in each of the other four toes.

1. 14 phalanges—2 in the great toe (hallux) and 3 in each of the other four toes.

How are the metatarsals numbered and what are the names of their two articular extremities?

1. Numbered 1–5 starting medially; proximal extremity is the base, distal extremity is the head.
2. Numbered 1–5 starting laterally; proximal extremity is the head, distal extremity is the base.
3. Numbered 1–5 starting medially; proximal extremity is the head, distal extremity is the shaft.
4. Numbered 1–5 starting laterally; proximal extremity is the shaft, distal extremity is the head.

1. Numbered 1–5 starting medially; proximal extremity is the base, distal extremity is the head.

Which joints are formed by the heads of the metatarsals and the proximal phalanges?

1. Metatarsophalangeal (MTP) joints.
2. Proximal Interphalangeal (PIP) joints.
3. Distal Interphalangeal (DIP) joints.
4. Tarsometatarsal (TMT) joints.

1. Metatarsophalangeal (MTP) joints.

Which of the following lists the seven tarsal bones in order from posterior to anterior, medial to lateral?

1. Calcaneus, talus, navicular, medial cuneiform, intermediate cuneiform, lateral cuneiform, cuboid.
2. Talus, calcaneus, navicular, medial cuneiform, lateral cuneiform, intermediate cuneiform, cuboid.
3. Calcaneus, navicular, talus, cuboid, medial cuneiform, intermediate cuneiform, lateral cuneiform.
4. Talus, calcaneus, cuboid, navicular, medial cuneiform, intermediate cuneiform, lateral cuneiform.

1. Calcaneus, talus, navicular, medial cuneiform, intermediate cuneiform, lateral cuneiform, cuboid.

Which tarsal bone is the largest and what common name is it also known by?

1. The calcaneus; also called the os calcis or heel bone.
2. The talus; also called the ankle bone.
3. The navicular; also called the boat-shaped bone.
4. The cuboid; also called the cube bone.

1. The calcaneus; also called the os calcis or heel bone.

Which tarsal bone occupies the highest position in the foot and articulates with the calcaneus at the subtalar joint?

1. Talus.
2. Calcaneus.
3. Navicular.
4. Cuboid.

1. Talus.

Where is the cuboid located?

1. On the lateral side of the foot between the calcaneus and the fourth and fifth metatarsals.
2. On the medial side of the foot between the talus and the navicular.
3. On the plantar surface, anterior to the calcaneus.
4. Superior to the talus, forming part of the ankle joint.

1. On the lateral side of the foot between the calcaneus and the fourth and fifth metatarsals.

Which cuneiform is the largest and which is the smallest?

1. The medial cuneiform is the largest, and the intermediate cuneiform is the smallest.
2. The lateral cuneiform is the largest, and the medial cuneiform is the smallest.
3. The intermediate cuneiform is the largest, and the lateral cuneiform is the smallest.
4. All cuneiforms are approximately the same size.

1. The medial cuneiform is the largest, and the intermediate cuneiform is the smallest.

Where are sesamoid bones most commonly found in the foot and why are fractures here painful?

1. On the plantar surface posterior to the first MTP joint; fractures are painful due to weight-bearing stress at that location.
2. On the dorsal surface near the ankle joint; fractures are painful due to nerve impingement.
3. Within the Achilles tendon; fractures are painful due to muscle spasms.
4. Near the cuboid bone; fractures are painful due to limited blood supply.

1. On the plantar surface posterior to the first MTP joint; fractures are painful due to weight-bearing stress at that location.

Name the two primary arches of the foot.

1. Longitudinal arch and transverse arch.
2. Medial arch and lateral arch.
3. Proximal arch and distal arch.
4. Anterior arch and posterior arch.

1. Longitudinal arch and transverse arch.

When should a grid be used for lower-limb radiography?

1. When the part measures over 10 cm (e.g., the knee).
2. When the part measures under 5 cm (e.g., the toes).
3. When using a high kVp technique.
4. For all lower-limb radiography procedures.

1. When the part measures over 10 cm (e.g., the knee).

Which essential projections are performed for the toes?

1. AP axial, AP oblique, and lateral (mediolateral or lateromedial).
2. AP, lateral, and tangential.
3. PA, oblique, and axial.
4. Dorsoplantar, plantodorsal, and specialized views.

1. AP axial, AP oblique, and lateral (mediolateral or lateromedial).

For an AP axial projection of the toes, how is the central ray directed?

1. 10–15° posterior (toward the heel) entering at the 3rd MTP joint

2. Perpendicular to the PIP joint of the affected toe

3. 40° cephalic, entering the plantar surface at the base of the 3rd metatarsal

4. 10° toward the heel, directed to the base of the 3rd metatarsal

1. 10–15° posterior (toward the heel) entering at the 3rd MTP joint; may be perpendicular if toes are elevated on a 15° wedge sponge.

What amount of rotation is used for an AP oblique projection of the toes?

1. 10–15° medial rotation

2. 30–45° medial rotation

3. 20–30° lateral rotation

4. 50–60° medial rotation

2. 30–45° medial rotation of the foot.

For lateral projections of the 1st–3rd toes, which side of the foot is placed against the IR?

1. Unaffected side down (lateromedial projection).
2. Affected side down (mediolateral projection).
3. Either affected or unaffected side, depending on patient comfort.
4. The plantar surface.

1. Unaffected side down (lateromedial projection).

For lateral projections of the 4th–5th toes, which side of the foot is against the IR and where is the CR centered?

1. Affected side down (mediolateral projection) with CR perpendicular to the PIP joint of the affected toe.
2. Unaffected side down (lateromedial projection) with CR perpendicular to the MTP joint.
3. Affected side down (plantodorsal projection) with CR angled 10° anterior.
4. Unaffected side down (dorsoplantar projection) with CR angled 15° posterior.

1. Affected side down (mediolateral projection) with CR perpendicular to the PIP joint of the affected toe.

Which essential projections are performed for the foot?

1. AP axial, AP oblique (medial rotation), and lateral (mediolateral).
2. AP, lateral, and external oblique.
3. PA, axial, and internal oblique.
4. Calcaneal axial, stress views, and tangential.

1. AP axial, AP oblique (medial rotation), and lateral (mediolateral).

Describe the CR for an AP axial foot projection.

1. 10° toward the heel, directed to the base of the 3rd metatarsal.
2. Perpendicular to the navicular.
3. 15° toward the toes, directed to the midfoot.
4. 40° cephalic, directed to the talus.

1. 10° toward the heel, directed to the base of the 3rd metatarsal.

How much medial rotation is used for an AP oblique foot, and what key anatomy does it best demonstrate?

1. 30–40° medial rotation; demonstrates the tuberosity of the 5th metatarsal and opens joints between the 3rd–5th metatarsals.
2. 10–15° lateral rotation; demonstrates the calcaneus and talus.
3. 45–50° medial rotation; demonstrates the navicular and cuneiforms.
4. 20–30° lateral rotation; demonstrates the metatarsal heads.

1. 30–40° medial rotation; demonstrates the tuberosity of the 5th metatarsal and opens joints between the 3rd–5th metatarsals.

What is a Jones fracture and where is it located?

1. An avulsion fracture of the base of the 5th metatarsal, also called a dancer’s fracture.
2. A spiral fracture of the distal tibia, common in sports injuries.
3. A fracture of the calcaneus, often from a fall.
4. A chip fracture of the talus, associated with ankle sprains.

1. An avulsion fracture of the base of the 5th metatarsal, also called a dancer’s fracture.

For a mediolateral lateral foot projection, how is the ankle positioned and where is the CR directed?

1. Foot dorsiflexed 90°; CR perpendicular to the base of the metatarsals (medial cuneiform).
2. Foot plantarflexed 90°; CR perpendicular to the midfoot.
3. Foot in natural position; CR angled anteriorly to the navicular.
4. Foot everted; CR perpendicular to the lateral malleolus.

1. Foot dorsiflexed 90°; CR perpendicular to the base of the metatarsals (medial cuneiform).

Which essential projections are performed for the calcaneus?

1. Axial (plantodorsal) and lateral (mediolateral).
2. AP and oblique.
3. Dorsoplantar and tangential.
4. Weight-bearing AP and lateral.

1. Axial (plantodorsal) and lateral (mediolateral).

State the CR angulation and entry point for a plantodorsal axial calcaneus.

1. 40° cephalic, entering the plantar surface at the base of the 3rd metatarsal.
2. 15° caudad, entering the dorsal surface at the ankle joint.
3. Perpendicular, entering the heel.
4. 25° cephalic, entering the posterior calcaneus.

1. 40° cephalic, entering the plantar surface at the base of the 3rd metatarsal.

For a lateral calcaneus, where is the CR centered?

1. Perpendicular, 1 inch (2.5 cm) distal to the medial malleolus at the subtalar joint.
2. Perpendicular, 1 inch (2.5 cm) proximal to the lateral malleolus.
3. Angled 10° posterior, at the calcaneal tuberosity.
4. Perpendicular, at the midfoot joint space.

1. Perpendicular, 1 inch (2.5 cm) distal to the medial malleolus at the subtalar joint.

Why is dorsiflexion of the ankle important in the axial calcaneus projection?

1. To place the plantar surface perpendicular to the IR and reduce elongation of the calcaneus.
2. To increase the magnification of the calcaneus.
3. To visualize the talonavicular joint space clearly.
4. To allow for better patient comfort during the exam.

1. To place the plantar surface perpendicular to the IR and reduce elongation of the calcaneus.

Which joint space should be visible on a correctly positioned lateral foot image?

1. The tibiotalar (ankle) joint.
2. The calcaneocuboid joint.
3. The cuneonavicular joint.
4. All metatarsophalangeal joints.

1. The tibiotalar (ankle) joint.

Which of the following evaluation criteria indicates a properly positioned AP axial projection of the toes?

1. The joint spaces (IP and MTP) should be open, and there should be no rotation or excessive angulation apparent.
2. The metatarsals should be significantly elongated.
3. The phalanges should appear foreshortened with closed joint spaces.
4. The sesamoid bones should be clearly separated from the 1st MTP joint.

The joint spaces (IP and MTP) should be open, and there should be no rotation or excessive angulation apparent.

For an AP oblique projection (medial rotation) of the foot, which of the following are key evaluation criteria?

1. The tuberosity of the 5th metatarsal should be clearly demonstrated in profile, and the 3rd-5th tarsometatarsal (TMT) joints should be open.
2. All cuneiforms should be completely superimposed.
3. The talus should be clearly visualized without any superimposition.
4. The calcaneocuboid joint should be completely closed.

1. The tuberosity of the 5th metatarsal should be clearly demonstrated in profile, and the 3rd-5th tarsometatarsal (TMT) joints should be open.

Upon evaluation of a lateral (mediolateral) projection of the foot, which structures should be clearly visible and open?

1. The tibiotalar (ankle) joint, talonavicular, and calcaneocuboid joints should be open with superimposition of the metatarsals.
2. The cuboid should be superimposed directly over the navicular.
3. All the individual phalanges should be distinctly separate from each other.
4. The cuneiforms should appear in a perfect side-by-side arrangement without overlap.

1. The tibiotalar (ankle) joint, talonavicular, and calcaneocuboid joints should be open with superimposition of the metatarsals.

Which of the following evaluation criteria indicates a correctly executed plantodorsal axial projection of the calcaneus?

1. The calcaneus should be shown in profile with no excessive rotation, and the talocalcaneal joint space should be clearly open with the sustentaculum tali visualized.
2. The Achilles tendon should be in profile, and the metatarsals should be fully included.
3. The entire talus should be clearly visible and elongated.
4. The joint space between the talus and navicular should be open.

1. The calcaneus should be shown in profile with no excessive rotation, and the talocalcaneal joint space should be clearly open with the sustentaculum tali visualized.