Toes, forefoot, foot and heel exam

how many bones are in the foot

26

how many bones are phalanges

14

how many bones are metatarsals

5

how many bones are tarsals

7

forefoot is considered

metatarsals and toes

mid foot is considered

5 tarsals

hind foot is considered

talus and calcaneus

dorsal/dorsum surface

looking down on the foot (top)

plantar surface

bottom of foot (planting feet)

what type of bones are phalanges

long bones

first metatarsal

shortest and thickest

2nd metacarpal

longest

what is on the 5th metatarsal

tuberosity

MTP joints

metatarsophalangeal

TMT joints

tarsometatarsal

IMT joints

intermetatarsal

what type of bones are tarsals

short bones

cuniforms

medial, intermediate and lateral

part of distal row of tarsals

talus bone

most superior

second largest tarsal bone

articulates with tib/fib, calcaneus, navicular

trochlear surface

attaches foot to leg, superior surface of talus

sulcus tali

inferior surface of talus

what makes up the sinus tarsi

sulcus tali, calcaneal sulcus

calcaneus

largest and strongest tarsal

posterior tuberosuty

3 articular facets: anterior middle, posterior

calcaneal sulcus

calcaneal sulcus

inbetween middle and posterior articular facets

sustentaculum tali

on medial ascept of heel (large)

trochlea

lateral aspect of heel

IP joint

hinge

MTP joint

ellipsoidal

IMT, TMT, calcaneocuboid, cuneocuboid, intercuneiform, naviculocuneiform, talocalcaneal joints

gliding

cuboidaonavicular joint

syndesmosis

Talocalcaneonavicular joint

ball and socket

sesamoid bones

2 small round bones

beneath the head of the first metatarsal

arches of the foot

Medial longitudinal arch

Lateral longitudinal arch

Transverse arch

Talipes (clubfoot)

deformity in which the foot is twisted out of shape or position (usually peds)

causes of talipes

idiopathic (increased risk with family history)

Radiographic appearance of talipes

abnormal flexion, abduction, inversion and/or eversion of foot

gout

sudden, or severe attacks of pain, redness and tenderness in joints, often in big toe

causes of gout

increase of uric acid in blood leads to deposition of uric acid crystals in joints, cartilage, and kidneys

radiographic appearence of gout

develops late, after repeated attacks, urate crystals form and erode underlying bone at joint

(ususally at MTP joint)

technical factor of gout

destructive

osteomyelitis

inflammation of bone and bone marrow

common in foot because of diabetic foot ulcers

causes of osteomyelitis

bacteria entering the body from injury or surgery

Radiographic appearance of osteomyelitis

ragged, moth-eaten appearance

technical factors of osteomyelitis

subtractive - decrease technique

bone spur

"osteophyte" - bony growth formed on normal bone

cause of bone spurs

typically forms in response to pressure, rubbing, or stress that continues over a long period of time

radiopgraphic appearance of bone spur

extra bone appears as parrot or hook

technichal factor of bone spur

additive condition

jones fracture

most common fracture of foot is at the base of the 5th metatarsal

causes of jones fracture

trauma, occurs with plantar flexion of foot

radiographic appearance of jones fracture

transverse fracture at base of 5th metatarsal

stress or fatigue fracture "March"

fractures in weight bearing bones cause by repetitive stress

causes of "March" or stress fracture

Prolonged and concentrated stress typically to the feet

radiographic appearance of March or stress fracture

Fracture lines or excess bony deposits around repetitively healing fractures

AP axial, medial oblique, lateral, toe/forefoot technique

63 kVp @ 0.9 mAs

AP axial toe central ray

tube angles 15 degrees towards the heel to the MTP joint of toe of interest

AP axial toe evaluation criteria

entire toe to metatarsal, separation, no rotation, open IP and MTP joints

Medial oblique toe central ray

to the MTP joint of toe of interest

AP axial forefoot central ray

tube angles 15 degrees toward the heel to the second MTP joint

medial oblique forefoot central ray

to the 3rd MTP joint

Lewis method

patient in prone position with big toe resting on the table in a dorsiflexion position. ball of the foot should be perpendicular to the horizontal plane

Holly method

patient seated on table with affected side held in dorsiflexion with medial border perpendicular and the plantar surface is at an angle of 75 degrees with the plane of the free detector

central ray for Holly and Lewis method

perpendicular and tangential to the head of the first MTP joint

AP axial, medial oblique and lateral foot technique

70kVp @ 1.25 mAs

AP axial foot central ray

tube angle 10 degrees towards the heel to the base of the 3rd metatarsal

Ap axial foot evaluation criteria

no rotation, overlap of the 2-5 metatarsal bases, improved demonstration of improved IP, MTP, TMT joints, open joint space between cuneiform

Medial oblique foot evaluation criteria

proper rotation

- 3-5 metatarsal free of superimposition

- bases of the 1-2 metatarsals superimposed on medial and intermediate cuneiform

- navicular, lateral cuneiform, and suboid with less superimposition than in the AP projection

tuberosity of 5th metatarsal

sinus tarsi is open

lateral foot central ray

to medial cuneiform at the base of the 3rd metatarsal

lateral foot evaluation criteria

RH: heads of metatarsals superimposed with the tuberosity of the 5th metatarsal seen in profile

Merrills: superimposed plantar surfaces of the metatarsal heads

- fibula overlapping the posterior portion of the tibia

- tibiotalar joint open

SPECIAL VIEW: lateral oblique foot (evaluation criteria)

1-2 metatarsal bases free of superimposition

minimal superimposition between medial and intermediate cuneiforms

navicular seen with less foreshortening than in the medial rotation AP oblique projection

AP axial heel technique

70 kVp @ 1.8 mAs

AP axial heel central ray

tube angled 40 degrees cephalad and enters around base of 3rd metatarsal

Ap axial heel evaluation criteria

calcaneus and talocalcaneal joint

no rotation of calcaneus

- sistentaculum tali in profile on medial side

- the 1 or 5 metatarsals not visible on either side

RH note for AP axial heel

the supine AP axial image is preferred, if pt is unable to tolerate can obtain reect heel using the Harris Beath method

lateral heel technique

70 kVp @ 1.1 mAs

lateral heel central ray

perpendicular to the heel and about 1-1 1/2 distal to the medial malleolus (subtalar joint)

lateral heel evaluation criteria

entire calcaneous, including ankle joint and adjacent tarsals

no rotation of calcaneus

- tuberosity in profile

- sinus tarsi open

- calcaneocuboid and talonavicular joints open

weight bearing Harris Beath method (coalition position)

demonstrates the calcaneotalar coalition

directions for Harris Beath method

pt stands in upright position, center free detector to the long axis of the calcaneus with the posterior surface of the heel at the edge of the free detector, have pt place the opposite foot one step forward, central ray is 45 degrees anteriorly and directed through the posterior surface of the flexed ankle to a point of the plantar surface at the level of the base of the 5th metatarsal