Calcaneus Anatomy Terms and Definitions for Medicine Study

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Mnemonic for the Tarsals?

Tarsal bones

the seven bones of the ankle

Calcaneus (os calcis)

Largest and strongest bone of the foot

Superior or proximal surface of Calcaneus

Which view of the calcaneus is this?

Posterior articular facet

Largest facet on calcaneus, articulates with talus

Anterior and middle articular facet

smaller facets that articulate with the talus to form the talocalcaneonavicular joint

Sustentaculum tali

Means "support for the talus", Located on the medial proximal aspect

Calcaneus sulcus

deep depression between the posterior and middle articular facets

Tuberosity of calcaneus

Common site for bone spurs, Achilles tendon attaches

Peroneal trochlea (trochlear process)

Visualized laterally on an axial projection

Sinus tarsi (tarsal sinus)

Visualized laterally, Ligaments pass through, opening in the subtalar joint, formed by a depression of the talus and calcaneal sulcus

Lateral process of calcaneus

Medial process of calcaneus

Talocalcaneal joint (subtalar joint)

articulation of the inferior surface of the talus and the superior surface of the calcaneus

-Cuboid-Anteriorly

-Talus-Superiorly

(Forms the subtalar (talocalcaneal) joint)

Which bones articulate with the calcaneus?

Calcaneus (os calcis)

5?

Sustentaculum tali

1?

Talocalcaneal joint (subtalar joint)

8?

Tuberosity 5th metatarsal

7?

Peroneal trochlea (trochlear process)

6?

Lateral process of calcaneus

4?

Medial process of calcaneus

2?

Talus (astragalus bone)

2nd largest tarsal bone, Located between lower leg and calcaneus, Weight of the body is transmitted by this bone through the ankle and talocalcaneal joints

Tibia-Superiorly

Fibula-Superiorly

Calcaneus-Inferior

Navicular-Anterior

Which bones articulate with the Talus?

Tibia

the medial and larger bone of the lower leg

lateral condyle of tibia

articulates with lateral condyle of femur

proximal tibiofibular joint

joint between fibula (head) and tibia (lateral condyle)

intercondyle eminence of tibia (tibial spine) (medial and lateral intercondylar tubercle)

Between the articular facets on the superior articular facet of the tibia

Tibial plateau (articular facets of tibia)

opposed ends of the bones, covered with hyaline cartilage

medial condyle of the tibia

articulates with medial condyle of femur

Tibial Tuberosity

point where the patellar ligament attaches

Anterior crest

Body or shaft of tibia

fibular notch

lateral notch on the distal end tibia where tibia and fibula articulate

Distal tibiofibular joint

articulation between the distal fibula and the fibular notch of the tibia

Medial malleolus

Easily palpated on medial side of ankle

Anterior Tubercle

Expanded process at the distal anterior & lateral tibia, Articulates with the superolateral talus, Partially overlaps the fibula anteriorly, (distal portion of tibia)

Tibial Plafond

Distal tibial joint surface, Forms the roof of the ankle mortise joint

Mortise space

"socket" or three-sided opening The superior Talus fits in here • Not seen on a true AP in full

fibula

apex of fibula (styloid process)

head of fibula

neck of fibula

body or shaft of fibula

lateral malleolus

bony prominence on the lateral side of the fibula (forms ankle)

distal end of fibula

Tibia: Proximally & Distally

Talus: Distally

Which bone articulates with the fibula?

1. tibia

2. fibula

3. talus

What 3 bones form the ankle joint?

Tibia

1?

Fibula

2?

Anterior Tubercle

3?

Medial malleolus

4?

lateral malleolus

5?

Mortise space

6? (joint space)

Sustentaculum tali

11?

Calcaneus (os calcis)

14?

Inferior surface of the tibia (tibial plafond / tibial facets)

When performing an axial projection of the ankle, what should you see?

Fiberglass: 3-4

Small to medium: 5-7

Large plaster cast: 8-10

How much do you change the kVp for casts?

radiopaque objects, clothing removed placed in gown , long hair, oxygen tubing, and pacemaker leads to avoid reduced detail/scatter

During patient preparation, what must be removed?

1. Limit the number of exposures

2. Collimation

3. shielding (led apron)

4. Position correctly

What 4 things help protect you and the patient against radiation?

BEFORE the examination

When must the anatomical marker be placed?

kVp: 65-75 (increase for other foot projections)

mAs: depends

Grid: No

SID: 40in

What technical factors are needed for a good ankle/calcaneus (kVp, grid, mA, SID)?

Plantodorsal (axial)

Dorsoplantar (axial)

Lateral

Routine projections of the calcaneus?

What is the evaluation criteria and procedure for an Plantodorsal axial Calcaneus X-ray?

kVp: 65-75

Grid: No

CR: base of 3rd metatarsal, 40° caudad from long axis of foot

Patient position: supine or seated on table with leg fully extended, Dorsiflex foot, align ankle joint to CR and IR, plantar surface near perpendicular

Evaluation criteria: entire calcaneus (tuberosity posteriorly to subtalar joint anteriorly)

What is the evaluation criteria and procedure for an Dorsoplantar axial Calcaneus X-ray?

kVp: 65-75

Grid: No

CR:

STANDING: direct CR to level of base of 5th metatarsal, 45° anteriorly and directed through posterior surface of flexed ankle

PRONE: CR directed to midpoint of the IR (will emerge at the level of the base of the 5th MT, Caudal angle 40˚ to long axis of foot

Patient position:

STANDING: standing upright with weight placed on affected foot, place opposite foot one step forward and lean forward as far as possible

PRONE: lying down foot elevated with plantar surface on IR

Evaluation criteria: entire calcaneus and tuberosity posteriorly

What is the evaluation criteria and procedure for an Lateral (mediolateral) Calcaneus X-ray?

kVp: 65-75

Grid: No

CR: 1 in inferior to medial malleolus

Patient position: lateral recumbent position, recumbent, Flex knee on affected limb 45˚

Evaluation criteria: calcaneus demonstrated in profile with talus and distal tib-fib.

AP

AP Mortise

Lateral (mediolateral)

Ankle Routine projections?

What is the evaluation criteria and procedure for an AP Ankle X-ray?

kVp: 60-75

Grid: No

CR: directed midway between malleoli

Patient position: Patient supine, leg fully extended, Do not force dorsiflexion, Foot & ankle in true AP

Evaluation criteria: Distal ⅓ of tibia and fibula demonstrated, Proximal ½ of metatarsals included, Medial and superior aspect of ankle joint open

What is the evaluation criteria and procedure for an AP Mortise X-ray?

kVp: 60-75

Grid: No

CR: directed midway between malleoli

Patient position: Patient supine, leg fully extended, Do not dorsiflex foot allow it to remain in natural position, Internally rotate leg & foot 15-20°

Evaluation criteria: Distal ⅓ of tibia and fibula demonstrated, Proximal ½ of metatarsals included, Medial and superior aspect of ankle joint open

What is the evaluation criteria and procedure for a Lateral (mediolateral)

Ankle X-ray?

kVp: 60-75

Grid: No

CR: directed at Medial Malleolus

Patient position: Patient in a lateral recumbent position, Flex affected limb 45˚, Dorsiflex foot so that plantar surface is at a right angle to leg or as far as patient can tolerate (DO NOT FORCE)

Evaluation criteria: Entire talus and calcaneus visualized, Lateral malleolus superimposed over posterior half of tibia

Oblique 45°

AP Stress (Inversion & Eversion)

AP & Lateral Weight Bearing

Ankle special projections?

What is the evaluation criteria and procedure for an AP Oblique ankle

X-ray?

kVp: 60-75

Grid: No

CR: directed midway between malleoli

Patient position: Supine, legs fully extended, dorsiflex foot to 80-85° and rotate leg and foot medially 45°

Evaluation criteria: Distal tibiofibular joint open, Distal ⅓ of tibia and fibula demonstrated, Proximal ½ of metatarsals included

What is the evaluation criteria and procedure for an AP stress ankle

X-ray?

kVp: 60-75

Grid: No

CR: directed midway between malleoli

Patient position: supine, legs fully extended, dorsiflex foot near right ankle lower leg as far as possible, then plantarflex and laterally bend as far as possible

Evaluation criteria: Distal aspect of tibia and fibula demonstrated and Ankle joint to center of collimation field

What is the evaluation criteria and procedure for an AP bilateral and lateral Weight Bearing X-ray?

kVp: 60-75

Grid: No

CR: directed midway between malleoli for AP and Medial malleolus for lateral

Patient position: both ankles in view, for the lateral do one ankle at a time

Evaluation criteria: Distal aspect of tibia and fibula demonstrated and Ankle joint to center of collimation field