Recent

  • Show all results for ""

🎧 New: AI-Generated Podcasts Turn your study notes into engaging audio conversations. Learn more

LOWER EXTREMETIES
142 Questions
0 Views

LOWER EXTREMETIES

Created by
@CheapestArtNouveau

Podcast Beta

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What does an angle less than 20 degrees suggest in relation to the foot?

  • A condition of pes cavus
  • An ankle sprain
  • A calcaneal fracture or posterior facet disruption (correct)
  • A normal foot structure

    • Which of the following describes pes planus?

  • A flat foot with no arch (correct)
  • A normal arch structure
  • An abnormal high arch
  • A condition involving multiple foot deformities

    • In the AP axial Projection Weight-bearing method, what is the recommended angulation of the CR?

  • No specific angulation required
  • 30° posteriorly
  • 20-25° toward the heel
  • 10-15° toward the heel (correct)

    • What is typically the most common foot deformity demonstrated in imaging?

    <p>Hallux valgus</p> Signup and view all the answers

    What is the primary focus of the lateromedial projection in assessing foot structures?

    <p>To demonstrate the structural status of the longitudinal arch</p> Signup and view all the answers

    What does a Lisfranc injury involve?

    <p>Dislocation of the tarsometatarsal joint</p> Signup and view all the answers

    During the composite method for AP axial projections, what should the affected foot do during the second exposure?

    <p>Step forward while weighting the talus and calcaneus</p> Signup and view all the answers

    Which statement is true regarding the intact healthy foot structure?

    <p>It consists of phalanges, metatarsals, cuneiforms, cuboid, talus, and calcaneus</p> Signup and view all the answers

    What is the positioning requirement for the lateral projection of the toes?

    <p>Lateral recumbent on the unaffected side</p> Signup and view all the answers

    Which technique is used for visualizing the tarsal sesamoid bone?

    <p>Tangential Projection: Causton Method</p> Signup and view all the answers

    What is the primary purpose of the AP oblique projection in foot imaging?

    <p>To better visualize the MTP joint spaces</p> Signup and view all the answers

    In the AP axial projection of the foot, what is the direction of the central ray (CR)?

    <p>15° toward the heel</p> Signup and view all the answers

    Which foot projection method can help localize foreign bodies?

    <p>AP Axial Projection</p> Signup and view all the answers

    Which technical adjustment is suggested to prevent superimposition during foot imaging?

    <p>Applying tape above the examined area</p> Signup and view all the answers

    What is the recommended degree of rotation for the AP oblique projection of the foot?

    <p>30° to 45°</p> Signup and view all the answers

    What aspect of foot anatomy does Bohler's angle evaluate?

    <p>Talus positioning in relation to the calcaneus</p> Signup and view all the answers

    What is the proper leg rotation when performing an AP oblique projection for the foot in medial rotation?

    <p>30°</p> Signup and view all the answers

    In a PA oblique projection, what is the position of the affected foot?

    <p>Elevated with the dorsal on the image receptor</p> Signup and view all the answers

    Which statement is true regarding the lateromedial projection technique?

    <p>The foot should be dorsiflexed at a 90° angle from the lower leg.</p> Signup and view all the answers

    What is Bohler's angle and its significance in foot imaging?

    <p>It is formed by the intersection of the lines A and B in a lateral ankle radiograph, with a normal range of 20 to 40 degrees.</p> Signup and view all the answers

    When performing a lateral projection of the foot, which orientation is preferred for the foot?

    <p>Lateral position with the lateral side close to the image receptor.</p> Signup and view all the answers

    What should be achieved to obtain a true lateral view of the foot?

    <p>All metatarsals should be visible in profile.</p> Signup and view all the answers

    During which angle should the heel be rotated in a PA oblique projection to visualize the interspace between the 1st and 2nd metatarsals?

    <p>30° medially</p> Signup and view all the answers

    What is commonly assessed using Bohler's angle in foot imaging?

    <p>Presence of fractures in the calcaneus</p> Signup and view all the answers

    What is the correct angle of medial rotation for the AP oblique projection of the foot?

    <p>30°</p> Signup and view all the answers

    In a PA oblique projection with lateral rotation, which interspaces are best visualized?

    <p>3rd &amp; 4th MT</p> Signup and view all the answers

    What is the positioning requirement for achieving a true lateral view of the foot?

    <p>1st - 3rd MT should be parallel to the IR</p> Signup and view all the answers

    Which aspect of the foot is shown in profile during an AP oblique projection?

    <p>Navicular</p> Signup and view all the answers

    What does Bohler's angle assess in foot imaging?

    <p>The angle between the talus and calcaneus</p> Signup and view all the answers

    When performing a lateral projection of the foot, how should the foot be positioned?

    <p>Lateral aspect in contact with the IR</p> Signup and view all the answers

    What is the normal range for Bohler's angle?

    <p>20 to 40 degrees</p> Signup and view all the answers

    In the AP oblique projection, what is the correct positioning of the knee?

    <p>Flexed at 30°</p> Signup and view all the answers

    What condition is characterized by the absence of an arch in the foot?

    <p>Pes planus</p> Signup and view all the answers

    What projection technique is used to examine structural status when both feet are evaluated in comparison?

    <p>Lateral Projection Weight-Bearing method</p> Signup and view all the answers

    Which of the following best describes a Lisfranc injury?

    <p>Dislocation of the tarsometatarsal joint</p> Signup and view all the answers

    In a standing AP axial projection, the feet should be positioned at what level?

    <p>At the level of the third metatarsal base</p> Signup and view all the answers

    What is the purpose of the 10-15° angulation in the AP axial projection weight-bearing method?

    <p>To align the foot's rays with the central ray</p> Signup and view all the answers

    During the first exposure of the AP axial projection weight-bearing composite method, what should the unaffected foot do?

    <p>Step backward to prevent superimposition</p> Signup and view all the answers

    What type of foot abnormality is hallux valgus classified as?

    <p>A deviation of the first metatarsal</p> Signup and view all the answers

    Which ligament is specifically mentioned in the mechanics of a Lisfranc injury?

    <p>Middle cuneiform ligament</p> Signup and view all the answers

    What is the purpose of the 15° angulation in an AP axial projection for the toes?

    <p>To reduce foreshortening of the phalanges</p> Signup and view all the answers

    In the Lewis method for tangential projection of the sesamoids, what is the positioning of the ankle?

    <p>Elevated with the great toe on the imaging receptor</p> Signup and view all the answers

    What is the correct foot rotation for the AP oblique projection to visualize the 1st through 3rd metatarsophalangeal joints?

    <p>30-45° medial rotation</p> Signup and view all the answers

    What does the Holly method for sesamoid projection require of the foot's position?

    <p>The medial border of the foot should be 1 inch from the imaging receptor</p> Signup and view all the answers

    Which positioning is necessary for a PA oblique projection of the toes?

    <p>Lateral recumbent with the affected side down</p> Signup and view all the answers

    What is the purpose of the occlusal film technique in foot projections?

    <p>To improve detail and resolution of the sesamoid bone</p> Signup and view all the answers

    In an AP axial projection of the foot, where is the central ray (CR) directed?

    <p>1 inch proximal to the base of the 3rd metatarsal</p> Signup and view all the answers

    Which projection method is recommended for obtaining a true lateral view of the toes?

    <p>Mediolateral positioning with the affected side down</p> Signup and view all the answers

    What structural condition is characterized by a lack of an arch in the foot?

    <p>Pes planus</p> Signup and view all the answers

    Which imaging technique is designed to assess the structural status of the longitudinal arch?

    <p>Lateral Projection Weight-Bearing method</p> Signup and view all the answers

    In relation to foot imaging, which condition is most commonly indicated by the appearance of a dislocated second metatarsal?

    <p>Lisfranc injury</p> Signup and view all the answers

    What is the angle of the central ray (CR) used in the first exposure of the AP axial projection weight-bearing method?

    <p>15°</p> Signup and view all the answers

    Which anatomical structures are primarily examined to identify hallux valgus?

    <p>Metatarsophalangeal joint</p> Signup and view all the answers

    What is the recommended positioning for the feet when using the AP axial projection weight-bearing method?

    <p>Feet placed 1 inch above the 3rd MT bone level</p> Signup and view all the answers

    During which phase of the AP axial Projection Weight-bearing Composite Method is the unaffected foot moved backward?

    <p>During the first exposure</p> Signup and view all the answers

    Which of the following foot conditions is described as having an abnormal arch?

    <p>Pes cavus</p> Signup and view all the answers

    What is the minimum degree of medial rotation required in the AP oblique projection to avoid overlapping of the lateral cuneiform with other cuneiforms?

    <p>30°</p> Signup and view all the answers

    What positioning is necessary for performing a PA oblique projection while visualizing interspaces between specific metatarsals?

    <p>Leg fully extended and turned toward midline</p> Signup and view all the answers

    Which of the following correctly describes the positioning technique for obtaining a lateral projection of the foot?

    <p>Dorsiflex foot 90° from lower leg</p> Signup and view all the answers

    During a lateral projection, how should the foot be oriented to achieve a true lateral view?

    <p>Lateral side of the foot close to IR</p> Signup and view all the answers

    What is the common method for obtaining a PA oblique projection of the foot?

    <p>Lateral aspect closer to IR</p> Signup and view all the answers

    What is the correct angle of rotation for assessing the interspace between the 2nd and 3rd metatarsals in a PA oblique projection?

    <p>20° lateral rotation</p> Signup and view all the answers

    What is the normal range for Bohler's angle as seen in the lateral ankle radiograph?

    <p>20 to 40 degrees</p> Signup and view all the answers

    Which of the following interspaces can be best visualized in the AP oblique projection of the foot?

    <p>Between the 1st and 2nd MT</p> Signup and view all the answers

    What is the correct positioning for the AP axial projection of the foot?

    <p>Supine with the knee flexed and the sole on IR</p> Signup and view all the answers

    During the PA oblique projection, which positioning adjustment allows for optimal visualization of the MTP joints?

    <p>Base of the foot forms a 30° angle to the horizontal</p> Signup and view all the answers

    What angulation is required for the CR in the AP axial projection of the foot?

    <p>10° towards the heel</p> Signup and view all the answers

    What is the purpose of the Lewis method in the tangential projection?

    <p>To clearly visualize the sesamoid bones at the 1st MT head</p> Signup and view all the answers

    Which projection technique specifically requires the affected limb to be lateral recumbent during the examination?

    <p>Tangential projection using the Causton method</p> Signup and view all the answers

    Which projection is best suited for reducing foreshortening in foot imaging?

    <p>AP axial with a 10° angulation</p> Signup and view all the answers

    When performing a medial rotation in an AP oblique projection, how many degrees should the foot be rotated?

    <p>30-45°</p> Signup and view all the answers

    What positioning is required to obtain a true lateral view of the toes?

    <p>Lateromedial or mediolateral, depending on the toe</p> Signup and view all the answers

    What is the primary indication of an angle less than 20 degrees in foot imaging?

    <p>Suggests a calcaneal fracture</p> Signup and view all the answers

    Which condition is characterized by a lack of arch in the foot?

    <p>Pes planus</p> Signup and view all the answers

    In the AP axial projection weight-bearing method, how should the feet be positioned?

    <p>Aligned at the base level of the 3rd MT bone</p> Signup and view all the answers

    What is true of hallux valgus?

    <p>It affects the MTP joint</p> Signup and view all the answers

    Which method is primarily utilized to assess the structural status of the longitudinal arch?

    <p>Lateral Projection Weight-Bearing method</p> Signup and view all the answers

    What is the purpose of angulating the central ray (CR) at 15 degrees in the AP axial projection?

    <p>To accurately evaluate the forefoot and metatarsals</p> Signup and view all the answers

    What characterizes a Lisfranc injury?

    <p>It is a dislocation of the tarsometatarsal joint</p> Signup and view all the answers

    What is the effect of a 10° angulation toward the heel in an AP axial projection of the foot?

    <p>Properly visualizes the 1st and 3rd MTP joints</p> Signup and view all the answers

    During the lateral projection of the foot, how should the position be adjusted?

    <p>Position the foot parallel to the imaging plate</p> Signup and view all the answers

    In which projection method are the toes medially rotated between 30-45° from the IR?

    <p>AP Oblique Projection</p> Signup and view all the answers

    Which method requires the foot to be dorsiflexed with the ankle elevated to visualize the sesamoid bone?

    <p>Lewis Method</p> Signup and view all the answers

    What is the primary purpose of the lateral recumbent position in a PA oblique projection of the toes?

    <p>To properly visualize the IP joint spaces</p> Signup and view all the answers

    In a lateral projection of the toes, which toes are positioned in true lateral?

    <p>1st and 2nd toes</p> Signup and view all the answers

    What common issue should be addressed to prevent superimposition during a foot examination?

    <p>Using tape or gauze above the evaluated toes</p> Signup and view all the answers

    Which projection method provides the best visualization of the interphalangeal joint spaces of the toes?

    <p>AP Oblique Projection</p> Signup and view all the answers

    When performing a sesamoid projection using the Holly method, what should the plantar surface be positioned against?

    <p>An imaging receptor</p> Signup and view all the answers

    What is the purpose of the PA oblique projection medial rotation when positioned with the lateral aspect closer to the image receptor (IR)?

    <p>To visualize the interspace between the 1st and 2nd metatarsals</p> Signup and view all the answers

    In a true lateral projection of the foot, which metatarsal bones should be primarily visualized?

    <p>1st to 3rd metatarsals</p> Signup and view all the answers

    During which projection method is the foot positioned on a 45° foam wedge?

    <p>PA oblique projection medial rotation</p> Signup and view all the answers

    What is the correct angle of rotation for the heel when performing a PA oblique projection for visualizing the interspace between the 2nd and 3rd metatarsals?

    <p>20° laterally</p> Signup and view all the answers

    Which aspect of foot anatomy does Bohler's angle encompass?

    <p>The angle formed by the calcaneal alignment</p> Signup and view all the answers

    What type of projection is described as requiring the affected foot to be elevated while in a prone position?

    <p>PA oblique projection</p> Signup and view all the answers

    Which of the following is true for the angulation of the foot in an AP oblique projection?

    <p>The foot is angled 30° medially to IR</p> Signup and view all the answers

    In what scenario would the lateral projection of the foot be considered difficult to achieve?

    <p>When the patient is unable to dorsiflex their foot</p> Signup and view all the answers

    In a lateral projection of the leg, what is the positioning of the femoral condyles in relation to the imaging receptor (IR)?

    <p>Parallel to IR</p> Signup and view all the answers

    What rotation is required for an AP oblique projection when medial rotation is performed?

    <p>45°</p> Signup and view all the answers

    Which projection method is used when a patient cannot turn for imaging of the tibia and fibula?

    <p>CROSS-Table Projection</p> Signup and view all the answers

    What is the result of medial rotation at the midshaft of the tibia during imaging?

    <p>Maximum interosseous space between tibia and fibula</p> Signup and view all the answers

    When performing a long leg CT, what is the correct technique regarding the unexposed part?

    <p>Cover with lead</p> Signup and view all the answers

    What is the correct position of the foot in the AP projection of the leg?

    <p>Dorsiflexed with toes pointing vertically</p> Signup and view all the answers

    How is the patient positioned for the lateral projection of the tibia and fibula?

    <p>Supine with the lateral side placed on the IR</p> Signup and view all the answers

    What is the positioning technique used for the AP oblique projection of the leg?

    <p>Rotate the leg 45° towards the midline</p> Signup and view all the answers

    What is one key difference when using the cross-table method compared to traditional positioning?

    <p>The CR is horizontal and the IR is positioned between the legs</p> Signup and view all the answers

    Which rotation maximizes the interosseous space between the tibia and fibula at the midshaft?

    <p>Medial rotation</p> Signup and view all the answers

    What should the foot's position be in the AP projection of the leg?

    <p>Dorsiflexed</p> Signup and view all the answers

    Which approach should be used when it is not possible to turn the patient for imaging?

    <p>Cross-Table Method</p> Signup and view all the answers

    In the lateral projection, where should the patella be positioned in relation to the image receptor?

    <p>Perpendicular to IR</p> Signup and view all the answers

    What is the degree of leg rotation for the AP oblique projection in medial rotation?

    <p>45°</p> Signup and view all the answers

    What is the result of performing a medial rotation at midshaft for the tibia and fibula?

    <p>Maximum interosseous space between tibia and fibula</p> Signup and view all the answers

    What is the appropriate leg rotation for an AP oblique projection in lateral rotation?

    <p>45° lateral rotation</p> Signup and view all the answers

    Which positioning technique is used when the patient cannot turn for a tibia and fibula projection?

    <p>Cross-Table with horizontal CR</p> Signup and view all the answers

    During a lateral projection (mediolateral) of the tibia and fibula, which position should the patient be in?

    <p>Supine turned toward the affected side</p> Signup and view all the answers

    What is an important consideration when performing a medial rotation of the tibia and fibula at midshaft?

    <p>Maximizing the interosseous space between the tibia and fibula</p> Signup and view all the answers

    In an AP projection of the leg, how should the foot be positioned?

    <p>Vertical with toes pointing upwards</p> Signup and view all the answers

    In an AP oblique projection, how should the leg be rotated?

    <p>45° medially or laterally</p> Signup and view all the answers

    What positioning adjustment is required for the lateral projection of the leg?

    <p>Turn the patient toward the affected side</p> Signup and view all the answers

    Which statement accurately describes the positioning of the femoral condyles in an AP projection?

    <p>They should be parallel to the image receptor</p> Signup and view all the answers

    What is the positioning requirement for a cross-table projection of the leg?

    <p>Place the IR between the legs with the CR directed vertically</p> Signup and view all the answers

    During lateral rotation, how does the tibia relate to the fibula?

    <p>The tibia superimposes the fibula</p> Signup and view all the answers

    In a lateral projection of the tibia and fibula, which positioning is required for the patella?

    <p>Patella perpendicular to the image receptor</p> Signup and view all the answers

    What is the best rotation technique for the AP oblique projection to maximize the interosseous space between the tibia and fibula?

    <p>Medial rotation of the leg</p> Signup and view all the answers

    When performing the cross-table projection, what is the orientation of the central ray?

    <p>Horizontal to the image receptor</p> Signup and view all the answers

    What specific positioning is required when using a 45° foam wedge for an AP oblique projection?

    <p>Ankle must rest on the wedge</p> Signup and view all the answers

    In lateral rotation of the leg during imaging, which anatomical relationship occurs between the tibia and fibula?

    <p>Fibula superimposes the tibia</p> Signup and view all the answers

    What is the recommended knee flexion angle for a lateral projection of the patella to ensure proper visualization?

    <p>5 to 10°</p> Signup and view all the answers

    In the Kuchendorf method for lateral oblique projection, what is the required angle of lateral rotation of the knee?

    <p>35-40°</p> Signup and view all the answers

    Which projection method allows for assessment of the femoral condyles as well as the patella?

    <p>Hughston method</p> Signup and view all the answers

    When using the Merchant method, at what angle should the knee be flexed?

    <p>40-45°</p> Signup and view all the answers

    What does a bipartite patella represent in radiological terms?

    <p>A normal variant</p> Signup and view all the answers

    What positioning is essential for ensuring the patella's medial portion is free of the femur in a PA oblique projection?

    <p>Knee flexed at 45-55°</p> Signup and view all the answers

    In the PA axial oblique projection with lateral rotation, what is the primary reason for placing the index finger against the patella?

    <p>To hold the patella in lateral displacement</p> Signup and view all the answers

    Which of the following describes the positioning needed for the Hughston method?

    <p>Recumbent with knees flexed 50-60°</p> Signup and view all the answers

    What position is required for the PA projection of the patella?

    <p>Prone with heel rotated laterally</p> Signup and view all the answers

    In a lateral projection of the patella, how much should the knee be flexed?

    <p>5-10 degrees</p> Signup and view all the answers

    Which projection technique allows for visualization of the medial portion of the patella free of femur?

    <p>PA Oblique Projection: Medial Rotation</p> Signup and view all the answers

    What angle is typically used for the knee in the KUCHENDORF method?

    <p>35-40 degrees laterally rotated</p> Signup and view all the answers

    What is the main purpose of the Merchant Method in patella imaging?

    <p>To demonstrate the sublaxation of the patella</p> Signup and view all the answers

    What is indicated if the knee flexion exceeds 10 degrees in a lateral projection of the patella?

    <p>Incomplete healing of patellar fracture</p> Signup and view all the answers

    What stage of patellar evaluation does the Laurin method primarily address?

    <p>Assessment of patellar sublaxation</p> Signup and view all the answers

    Which projection method requires the patient to be supine with both knees flexed between 40-45 degrees?

    <p>Merchant Method</p> Signup and view all the answers

    Study Notes

    Document Information

    • A specific date is mentioned in the document.
    • A specific time is recorded in the document.
    • The content's nature is described as a specific type.
    • The second part of the mentioned project likely focuses on a particular area.
    • A likely feature of this document format is that it is related to scheduling or outlining a plan.

    Text Analysis

    • The text appears to be asking questions about a document.
    • The questions are detailed, focusing on specific aspects of the document.
    • This suggests the document may be an official record or report containing key information.
    • The questions inquire about the document's contents and its purpose.
    • The information requested is likely to be important for understanding the document and its use.

    Foot Projections

    • Angles less than 20 degrees can suggest a calcaneal fracture or disruption of the posterior facet.

    • Lateral Projection Weight-Bearing

      • Upright position, distribute equal weight on each foot.
      • Feet elevated 1 inch above the third metatarsal bone.
      • IR positioned between the feet.
      • Weight equally distributed on each foot.

    • Lateromedial Projection Weight-Bearing

      • Patient stands with foot on IR.

    • Demonstrate:

      • The structural status of the Longitudinal arch.
      • (pes planus) Flat foot: A foot with a weak or no arch.
      • (pes cavus) Abnormal arch:
      • A foot with an abnormally high arch.

    Weight Bearing Foot

    • AP Axial Projection Weight-Bearing (Standing)

      • Patient stands with both feet against the IR, equal weight distribution.
      • 10 to 15 degrees of angulation towards the heel.
      • Feet level with the third metatarsal bone base.
      • Accurately evaluates the tarsals and metatarsals.

    • Hallux Valgus:

      • The most common foot deformity.
      • It affects the metatarsophalangeal (MTP) joint.

    • Lisfranc Injury:

      • This is a dislocation of the tarsometatarsal joint.

    • AP Axial Projection Weight-Bearing Composite Method (Standing)

      • Upright position.
      • Two exposures are taken in a specific sequence.
      • Affected foot steps on IR
      • First exposure:
        • CR directed for the forefoot.
        • Unaffected foot steps backward.
          • This prevents superimposition of the leg shadow over the metatarsals and phalanges
      • Second exposure:
        • CR directed for the hindfoot.
        • Unaffected foot:
          • CR is directed posteriorly 25 degrees
        • Affected foot:
          • Step forward to visualized the talus & calcaneus.
          • 15 Degrees posteriorly.
          • CR directed to the base of the third metatarsal bone.

    Mechanism of Lisfranc Injury

    • Medial View of the foot:
      • The second metatarsal is normally positioned distally.
      • Dislocation of the second metatarsal is a sign of Lisfranc injury.
    • Dorsal view of the foot with weight bearing:
      • The second metatarsal is normally positioned distally.
      • Under normal conditions, there is space between the bones due to ligaments.
      • Ligaments of the middle cuneiform, medial cuneiform, and navicular are important for maintaining foot stability.
    • Healthy foot:
      • The foot structure includes phalanges, metatarsals, cuneiforms, cuboid, talus, and calcaneus.
    • Lisfranc Foot:
      • The foot structure includes phalanges, metatarsals, cuneiforms, cuboid, talus, and calcaneus.
      • Lisfranc injury is a disruption of the ligaments and often results in bone displacement (fracture).
      • Fractures of the seventh metatarsal anterior often result in ligamentous instability.
      • Provides a general overview of the foot bones.

    Lateralside Seen

    • AP Oblique Projection (Medial Rotation)

      • Supine position with the knee flexed.
      • Plantar surface of the foot on IR, rotate leg medially 30 degrees.

    • Farthest Seen:

      • Less than 30 degrees of rotation may result in overlap of the lateral cuneiform over other cuneiforms in profile.
      • Increased angulation leads to open MTP spaces.

    • Interspaces b/n:

      • Visualize the interspaces between the calcaneus, cuboid, fifth, and fourth metatarsals.
      • Also, visualize the interspaces between the talus, navicular, lateral cuneiform, and sinus tarsi.

    • Medial part seen:

      • Interspaces between the 1st & 2nd MT, medial and intermediate cuneiforms are visible.
      • Navicular in profile.

    • AP Oblique bones of Foot:

      • Visualize the interspaces of the proximal end of the metatarsals.

    Nearest Seen

    • PA Oblique Projection
      • Prone position with the affected foot elevated.
      • The dorsal surface of the foot rests on the IR.
      • Grashey method is utilized.
      • Medial Rotation: Heel rotated medially 30 degrees for visualization of the interspace between the 1st & 2nd MT.
      • Lateral Rotation: Heel rotated laterally 20 degrees for visualization of the interspaces between the 2nd & 3rd MT, 3rd & 4th MT, and 4th & 5th MT.
    • PA Oblique Projection (Medial rotation)
      • Lateral recumbent position, affected side up.
      • Knees are flexed.
      • Leg is fully extended.
      • Patient rotates towards the midline prone.
      • Dorsum of the foot rests on a 45° foam wedge.
      • Similar to AP oblique projection of the foot medial rotation.
      • The lateral aspect of the foot is closer to the IR; more oblique than Grachey method.

    Lateral Projection

    • Lateromedial

      • The affected side is turned towards the IR.
      • Leg and foot are in lateral position.
      • Lateral side of the foot close to IR.
      • Dorsiflex the foot 90 degrees from the lower leg.
      • Most routinely used.

    • Lateromedial (difficult to assume)

      • Supine position.
      • Using an LPO/RPO position with affected side up.
      • Medial surface on IR.
      • Plantar surface of the foot on IR.
      • Foot in Lateral position.

    • TRUE Lateral FOOT

      • The 1st to 3rd metatarsal bones are visualized.
      • True Lateral of Foot is achieved when the lateral side of the foot is closest to the IR.

    • Lateromedial

      • Visualize the medial and lateral aspects.

    Bohler's Angle (a.k.a., "Tuber Angle")

    • Established by intersection of two lines in the lateral ankle radiograph.
    • Normal range is 20 to 40 degrees.

    Toes Projection

    • AP or AP Axial Projections:

      • Seated or supine position with knees flexed.
      • AP: 15 inch foam wedge is used.
      • AP Axial: 15 inches posteriorly.

    • PA Projection:

      • Prone position, dorsal aspect of the foot on IR.
      • IR parallel to 18 degrees.
      • CR Directed to: 3rd MTP Joint**

    • Partial CR: 15°

    • Well visualized Phalanges and Distal Metatarsals.

    • Axial CR:

      • More open interphalangeal joint (IP joint) spaces.
      • Reduced foreshortening of the structures.

    • AP Axial CR: 15°

    • Well visualized 1st to 3rd MTP joints spaces.

      • Well visualized Sesamoid bones of 1st Metatarsal.

    • Medial Rotation:

      • AP Oblique Projection
      • Supine or seated with knees flexed.
      • Rotate lower leg and foot medially.
      • 30 to 45 degrees from the IR.
      • Plantar surface of foot on IR. -Lateral Rotation:
      • 3rd to 5th lateral oblique toes.
      • MTP joints overlapped

    • PA Oblique Projection:

      • Lateral recumbent (affected side up).
      • Partially extended affected limb.
      • The base of the foot rests on a 30 degrees to horizontal (Patient toward prone).

    • Lateral:

      • Lateromedial/Mediolateral.
      • Great toe and second toe in true Lateral.
      • Lateral recumbent position, unaffected side up.
      • Superimposition can be avoided by:
        • Tape, gauze, or occlusal film.
        • One toe is examined at a time.

    • Mediolateral:

      • Visualize the 3rd, 4th, and 5th toes.
      • 3rd Toe Open (2nd to 5th MTPs closed).
      • Open MTP joint spaces with a slight degree of obliquity.
      • The 1st MTP joint might not be seen in the lateral projection.
      • The Apo and Proproy processes (medial and lateral aspects) might not be seen in this projection.
      • The 2nd to 5th MTP joint spaces are also open.

    • Other toes:

      • Visualize the proximal interphalangeal joint (PIP joint ).

    • Lateral

      • Lateromedial:
        • Visualize the 1st & 2nd toes.
      • Mediolateral:
        • Visualize the 3rd, 4th, and 5th toes.
        • Open IP Jts spaces.
      • True Lateral:
        • Lateral side of the foot closest to the IR.

    Sesamoids Projections

    Tangential Projection:

    • Lewis Method:
      • Prone position.
      • Great toe rests on the IR with dorsiflexion.
      • Ankle elevated.
      • Ball of foot 1 to IR.
      • Visualization of Sesamoid bone.
      • Visualization of the first MT head.
    • Holly Method:
      • Seated position (more comfortable).
      • Medial border of the foot 1 to the IR.
      • Plantar surface to IR.
      • The toes are flexed, held in place with gauze.
      • Visualization of the 1st MT head.
      • Visualization of the tarsal sesamoid bone.
    • ** Tangential Projection: Causton Method **
      • Lateral recumbent (unaffected side).
      • Knees are flexed.
      • Partially extended limb, foot in lateral position.
      • 1st MTP joint to IR with 40 degrees to the prominence of the 1st MIP.
      • Visualization of tarsal sesamoid bone.
      • Slight overlap axiolaterally.
    • Occlusal film technique: - To enhance the detail.

    Foot Projection

    • AP or AP Axial Projection:
      • Supine position;
      • Knee is flexed, sole on IR.
    • Visualize the 1st to 3rd MTP joints.
    • AP Axial: 10 degrees towards the heel.
      • CR directed 1 to MT bone.
    • RP: Base of 3rd MT bone
    • Elongated (10Ëš angulation):
      • Reduces foreshortening of the structures.
      • Visualize the Talus, Metatarsals, Phalanges, TMT Joint.
      • Enhances visualization.
    • (10°) axial:
      • Used for localizing foreign bodies in the foot.

    Toes Projections

    • AP or APaxial Projections:
      • Seated or supine position with knees flexed
      • AP: 15" foam wedge
      • Aparial: 15" posteriorly
    • PA Projection:
      • Prone position with dorsal aspect of foot on IR
      • IR parallel to 18°
    • CR: 1 to 3rd MTP joint for all projections
    • Partial CR (15°): for phalanges and distal metatarsals
    • Apaxial CR (open): for interphalangeal joints (IP Jt), reduces foreshortening
    • Aarial CR (15°): for 1st - 3rd MTP Jt, helps visualize IP Jt spaces and sesamoid bone of 1st metatarsal.
    • Medial Rotation (AP oblique Projection):
      • Supine or seated with knee flexed
      • Lower leg/foot rotated medially 30-45° from IR
      • Plantar aspect of foot on IR
    • Lateral Rotation: for 3rd - 5th lateral oblique toes, MTP Jts overlapped
    • PA oblique Projection:
      • Lateral recumbent on affected side with partial extension of affected limb
      • Base of foot at 30° to horizontal, plantar toward prone
    • Lateral: Lateromedial/Mediolateral position
      • Great toe and 2nd toe in true lateral position
      • Lateral recumbent (unaffected side)
    • Mediolateral: for 3rd, 4th, 5th toes (affected side)
    • 3rd Open, 2nd to 5th MTP Jt: visualizes MTP Jt spaces and oblique toes
    • 1st MTP Jt: not always open
    • Apo Pros (medial not): open 2nd - 5th MTP joint space
    • Proproy (medial not): open 2nd - 5th MTP joint space
    • PIP joint: other toes

    Sesamoids Projections

    • Tangential Projection: visualizes the sesamoid bone and 1st MT head
      • Lewis Method:
        • Prone with great toe on IR and dorsiflexed
        • Ankle elevated with ball of foot 1 to IR
      • Holly Method:
        • Seated position with medial border of foot 1 to IR
        • Plantar surface on IR, toes flexed and held with a strip of gauze
      • Causton Method:
        • Lateral recumbent on unaffected side with knees flexed and limb partial extended
        • Foot in lateral position, MTP joint 1 to IR, 40° prominence toward 1st MIP
    • Occlusal film technique: used for improved detail

    Foot Projection

    • AP or AP axial Projection:
      • Supine position with knee flexed, sole on IR, 1st - 3rd MTP Jt
    • AP axial: 10° toward the heel
    • CR: directed 1 to MT bone
    • RP: base of 3rd MT bone
    • Elongated (10° angulation):
      • Reduces foreshortening
      • Visualizes talus, metatarsals, phalanges, TMT Jt
      • Provides better detail

    Lateralside Seen

    • AP oblique projection medial rotation:
      • Supine position with knee flexed, plantar aspect of foot on IR
      • Rotate leg medially; Plantar aspect of foot at 30° to IR
    • Interspace b/n:
      • Calcaneus and Cuboid
      • Cuboid and 5th MT
      • 4th MT
      • Talus and Navicular
      • Lateral cuneiform
      • Sinus Tarci
    • Medial part seen:
      • Interspace b/n:
        • 1st & 2nd MT
        • Medial and intermediate cuneiform
      • Navicular in profile
    • AP oblique bones of Foot: visualizes interspaces of the proximal end of the bones of foot.

    Nearest Seen

    • PA oblique Projection:
      • Prone position with affected foot elevated, dorsal of foot on IR
    • Grashey Methods:
      • Medial or lateral rotation of heel:
        • Heel Medially rotated 30°:
          • Visualizes interspace b/n 1st & 2nd MT
        • Heel Laterally rotated 20°:
          • Visualizes interspace b/n 2nd & 3rd MT
          • 3rd & 4th MT
          • 4th & 5th MT
    • PA oblique Projection Medial rotation:
      • Lateral recumbent (affected side) with knees flexed and leg fully extended
      • Turn towards midline prone
      • Dorsum on 45° foam wedge
      • More oblique than Grashey, lateral aspect of foot closer to IR.

    Lateral Projection

    • Latero medial:
      • Turn towards affected side with leg and foot in lateral position
      • Lateral side of foot close to IR
      • Dorsiflex foot 90° from lower leg
    • Latero medial (difficult to assume):
      • Supine position
      • LPO/RPO with affected side up
      • Medial surface on IR
      • Plantar surface of foot on IR
      • Foot in lateral position
    • TRUE Lateral FOOT:
      • Visualizes 1st - 3rd MT bone
      • Achieved by latero medial and mediolateral positions

    Bohler's Angle

    • Bohler's angle (Tuber Angle): formed by lines A and B on a lateral ankle radiograph
    • Normal range: 20-40 degrees
    • Angles <20 degrees: suggestive of a calcaneal fracture or disruption of the posterior facet

    Longitudinal Arch

    • Lateral Projection Weight-Bearing method:
      • Upright with feet elevated 1 inch above the 3rd MT bone
      • IR b/n feet with weight equally distributed on each foot
      • Visualizes lateromedial of bones of foot, comparison of both feet
    • Lateromedial (Standing): per foot
    • Demonstrates the structural status of the longitudinal arch
    • Pes Planus (flat foot): no arch, weak
    • Pes Cavus (abnormal arch): abnormal arch

    FOOT weight bearing

    • AP axial Projection Weight-bearing method Standing:
      • Standing with both feet against IR and weight equally distributed
      • 10-15° toward the heel
      • Feet at 3rd MT base level
      • Accurate evaluation of ticals and metatarsals when comparing images
    • Demo of Hallux valgus: most common foot deformity, affects MTP joint
    • Lisfranc injury: dislocation of tarsometatarsal joint
    • AP axial Projection Weight-bearing Composite Method Standing:
      • Upright position
      • 2 exposures with affected foot stepping on IR
      • 1st exposure:
        • Forefoot tube, unaffected foot steps back (prevents MT and phalanges superimposition on leg shadow)
      • 2nd exposure:
        • Hindfoot tube, affected foot steps forward (visualizes talus and calcaneus)
      • 1st exposure: unaffected foot for posterior part
      • 2nd exposure: affected foot with 25° angulation CR of part for anterior part

    Mechanism of Lisfranc Injury

    • Medial view of the foot:
      • Normal position: 2nd metatarsal (distal first)
      • Dislocation: 2nd metatarsal
    • Dorsal view of the foot with weight bearing:
      • Normal position: 2nd metatarsal (distal first)
      • Space between bones under normal ligament
      • Ligament of the Middle cuneiform
      • Medial cuneiform
      • Ligament
    • HEALTHY FOOT:
      • Phalanges
      • Metatarsals
      • Cuneiforms
      • Cuboid
      • Talus
      • Calcaneus
    • LISFRANC FOOT:
      • Phalanges
      • Metatarsals
      • Cuneiforms
      • Cuboid
      • Talus
      • Calcaneus
      • Ligament
      • Ligament

    Toes Projections

    • AP Projection:
      • Patient is Seated or Supine
      • Knees are Flexed
      • 15" foam wedge is used
    • AP Axial Projection:
      • Patient is Seated or Supine
      • Knees are Flexed
      • 15" foam wedge is used Posteriorly
    • PA Projection:
      • Patient is Prone
      • Dorsal aspect of foot is placed on the IR
      • IR is parallel with 18°
    • CR for all Toes Projections:
      • 1 to the 3rd MTP joint

    Toes Projections (Specifics)

    • Partial CR (15°)
      • Visualizes Phalanges and Distal Metatarsals
    • Apaxial (Open CR)
      • Visualizes the Interphalangeal Joint (IP Joint)
      • Reduces foreshortening of the Phalanges
    • Axial CR (15°)
      • Visualizes the 1st to 3rd MTP Joints
      • Allows for visualization of the IP Joint spaces
      • Visualizes the sesamoid bone of the 1st Metatarsal
    • Medial Rotation (AP Oblique)
      • Patient is Seated or Supine
      • Knee is Flexed
      • Lower Leg/Foot is medially rotated
      • 30-45° angle from IR
      • Foot placed Plantar on the cassette
    • Lateral Rotation
      • Used for 3rd to 5th Lateral Oblique toes
    • PA Oblique Projection
      • Patient is in Lateral recumbent position (affected side down)
      • Affected Limb is partially extended
      • Base of the foot is positioned at a 30° angle to the horizontal (PT towards prone)
    • Lateral
      • Lateromedial or Mediolateral are used
      • Great Toe and 2nd Toe are visualized in True Lateral
      • Patient in Lateral recumbent (unaffected side down)
    • Preventing superimposition:
      • Tape or place gauze above the toe being examined
      • Occlusal film or stick may be used
    • Mediolateral
      • 3rd, 4th, 5th toes are visualized (affected side)
    • 3rd Open, 2nd to 5th MTP joint
      • Allows for visualization of the MTP Joint spaces
      • Used with Oblique Toes Projections
    • 1st MTP Joint
      • Not always open on 3rd Open position
    • Apo Pros (medial not)
      • Allows for visualization of the 2nd to 5th MTP joint spaces
    • Proproy (medial not)
      • Allows for visualization of the 2nd to 5th MTP joint spaces
    • Other Toes
      • PIP (Proximal Interphalangeal) Joints are visualized
    • Lateral
      • Lateromedial: 1st & 2nd Toes
      • Mediolateral: 3rd, 4th, 5th Toes
      • Allows for visualization of the IP Joint spaces
    • True Lateral
      • Used for all toes

    Sesamoid Projections

    Tangential Projection:

    • Lewis Method
      • Patient is Prone
      • Great Toe is placed on the IR, Dorsiflexed
      • Ankle is elevated
      • Ball of foot is 1 to the IR
      • Sesamoid bone and 1st MT head are visualized
    • Holly Method
      • Patient is Seated (more comfortable position)
      • Medial Border of the foot is 1 to the IR
      • Plantar surface of foot is placed on the IR
      • Toe is Flexed; PT holds toes with a strip of gauze
      • 1st MT head and tarsal sesamoid bone are visualized
    • Tangential Projection: Causton Method
      • Patient is in Lateral recumbent (unaffected side down)
      • Knee is Flexed
      • Limb is partially Extended
      • Foot is in lateral position
      • MTP Joint 1 is placed on the IR
      • 40° angulation is applied towards the prominence of the 1st MIP
      • Tarsal sesamoid bone is visualized
      • Axiolaterally with slight overlap

    Foot Projection

    • AP or AP Axial Projection:
      • Patient is Supine
      • Knee is Flexed
      • Sole of foot is placed on the IR
      • Visualizes the 1st to 3rd MTP Joints
    • AP Axial: 10° toward the Heel
    • CR is Directed 1 to MT bone
    • RP: Base of the 3rd MT Bone
    • Elongated (10° angulation):
      • Reduces foreshortening of Talus, Metatarsals, Phalanges, TMT Joint
      • Better visualization of the Foot bones

    Lateral Side Seen

    • AP Oblique Projection (Medial Rotation)
      • Patient is Supine
      • Knee is Flexed
      • Plantar surface of foot is placed on IR
      • Leg is Medially Rotated; Plantar surface is at 30° angle to the IR

    Farthest Seen

    • Less than 30°: The Lateral cuneiform bone is thrown over other cuneiform bones in profile

    • Greater angulation = Open MTP spaces

    • Interspace b/n:

      • Calcaneus and Cuboid
      • 5th and 4th MT
      • Talus and Navicular
      • Lateral cuneiform
      • Sinus Tarci

    • Medial Part Seen

      • Interspace b/n:
        • 1st and 2nd MT
        • Medial and Intermediate cuneiform
      • Navicular is visualized in profile

    • AP Oblique Bones of the Foot

      • Visualizes the interspaces of the Proximal ends of the foot bones

    Nearest Seen

    • PA Oblique Projection

      • Patient is Prone
      • Affected foot is elevated
      • Dorsal aspect of the foot is placed on IR

    • Grashey Method

      • Medial Rotation:
        • Heel is Medially Rotated 30°
        • Visualizes the interspace b/n 1st and 2nd MT
      • Lateral Rotation:
        • Heel is Laterally Rotated 20°
        • Visualizes interspace b/n 2nd and 3rd MT
        • Visualizes interspace b/n 3rd and 4th MT
        • Visualizes interspace b/n 4th and 5th MT

    • PA Oblique Projection (Medial Rotation)

      • Patient is in Lateral recumbent position (affected side down)
      • Knee is Flexed
      • Leg is fully extended
      • Patient turns towards the midline in prone position
      • Dorsum is placed on a 45° foam wedge
        • Same as AP Oblique of the Foot (Medial Rotated)
      • Lateral aspect of the foot is closer to the IR
        • More oblique than Grachey Method

    Lateral Projection

    • Lateromedial
      • Patient turns towards the affected side
      • Leg and foot are in lateral position
      • Lateral side of the foot is close to the IR
      • Foot is Dorsiflexed 90° from the lower leg
      • More routinely utilized
    • Lateromedial (difficult to assume)
      • Patient is Supine
      • LPO/RPO
      • Affected side is up
      • Medial surface of the foot is placed on IR
      • Plantar surface of the foot is placed on IR
      • Foot is in Lateral position
    • TRUE LATERAL FOOT
      • Visualizes the 1st to 3rd MT bone
      • Is achieved with Lateromedial
    • Medial
      • Lateral

    Bohler's Angle (a.k.a., "Tuber Angle")

    • Bohler's angle (aka "Tuber Angle") is visualized on the lateral ankle radiograph
    • Formed by the intersection of lines A and B
    • The normal range is 20 to 40 degrees.
    • Angles <20 degrees suggests a calcaneal fracture or disruption of the posterior facet

    Longitudinal Arch

    • Lateral Projection Weight-Bearing Method

      • Patient is Upright
      • Feet are elevated 1" above the 3rd MT bone
      • IR is placed b/n the feet
      • Weight is equally distributed on each foot
      • Lateromedial of the bones of the foot are visualized
      • Both feet are examined for comparison

    • Lateromedial (Standing)

      • Evaluates per foot

    • Demonstrate:

      • Structural status of the Longitudinal arch

    • (pes planus) Flat foot:

      • Absence of arch
      • Weak arch

    • (pes cavus) Abnormal arch:

      • Excessive arch

    Foot Weight-Bearing

    • AP Axial Projection Weight-bearing Method (Standing)

      • Patient Standing
      • Both feet are placed against the IR
      • Equal weight distribution on each foot
      • 10-15° angle toward the heel
      • Feet are at the 3rd MT base level
      • Evaluates the ticals and metatarsals

    • Demo of: Hallux valgus (most common foot deformity)

      • MTP Joint is affected

    • Lisfranc injury:

      • Dislocation of the Tarsometatarsal Joint

    • AP Axial Projection Weight-bearing, Composite Method (Standing)

      • Patient is Upright
      • 2 exposures are required
      • Affected foot steps on the IR
      • 1st exposure:
        • Forefoot Tube is used
        • Unaffected foot steps back
          • (Prevents the MT & Phalanges from superimposition on the leg shadow)
      • 1st Exposure:
        • Unaffected foot:
          • Hindfoot Tube is used with posterior exposure
          • 25° angulation is applied to the CR of the part
      • 2nd Exposure:
      • Affected foot:
        • Step forward (talus & calcaneus)
        • Posterior Part

    • 15° posteriorly

    • Base of 3rd MT bone

    Mechanism of Lisfranc Injury

    • Medial view of the foot:
      • Normal position of the 2nd Metatarsal (distal first)
      • Dislocation of the 2nd Metatarsal
    • Dorsal view of the foot (weight-bearing):
      • Normal position of the 2nd Metatarsal (distal first)
      • Space between bones under normal ligament
      • Ligament of the Middle Cuneiform
      • Medial Cuneiform
      • Medial Cuneiform
      • Ligament
    • HEALTHY FOOT:
      • Phalanges
      • Metatarsals
      • Cuneiforms
      • Cuboid
      • Talus
      • Calcaneus
    • LISFRANC FOOT:
      • Phalanges
      • Metatarsals
      • Cuneiforms
      • Cuboid
      • Talus
      • Calcaneus
      • Ligament
      • Ligament

    Toes Projections

    • AP or AP axial Projections:
      • Seated or supine position with knees flexed
      • AP: 15-inch foam wedge for foot elevation
      • AP axial: 15-inch posterior elevation
    • PA projection:
      • Prone position with dorsal aspect of foot on IR
      • IR parallel to 18°
    • Central Ray (CR): directed to the 3rd MTP joint
    • Partial CR at 15°:
      • For visualizing phalanges and distal metatarsal
    • Apaxial CR:
      • Open position for visualizing interphalangeal joint space
      • Reduces foreshortening of the toes
    • Aarial CR at 15°:
      • Visualizes the spaces of 1st-3rd MTP joints
      • Provides clear view of IP joints
      • Shows the sesamoid bone of the 1st metatarsal
    • Medial Rotation (AP Oblique):
      • Visualizes the lateral aspect of the toes
      • Supine or seated position with knee flexed
      • Rotate lower leg and foot medially by 30-45°
      • Plantar aspect of foot on IR
    • Lateral Rotation:
      • Visualizes the 3rd-5th toes
      • MTP joints are overlapped in this projection
    • PA Oblique Projection:
      • Lateral recumbent position with affected side down
      • Partially extend the affected limb
      • Base of foot forms 30° angle to horizontal
    • Lateral Projection:
      • Lateromedial or Mediolateral position
      • True lateral position for visualizing the great toe and second toe
      • Lateral recumbent position with unaffected side up
    • Mediolateral Projection:
      • Visualizes 3rd, 4th, and 5th toes on the affected side
      • Demonstrates the MTP joint spaces
    • 3rd Toe Open:
      • Visualizes the 2nd to 5th MTP joint spaces
      • Achieved through oblique toe projections
    • 1st MTP Joint:
      • Not always open in all projection
      • AP (medial) projection often does not visualize the 1st MTP space
      • PA projection (medial) often does not visualize the 1st MTP space
    • Proproy Projection:
      • Visualizes the 2nd-5th MTP joint spaces
    • Lateral Projection for other Toes:
      • Visualizes PIP joints
      • Lateromedial: for 1st and 2nd toes
      • Mediolateral: for 3rd, 4th and 5th toes; opens IP joint spaces

    Sesamoids Projections

    • Tangential Projection:
      • Visualizes sesamoid bones and 1st MT head
    • Lewis Method:
      • Prone position with great toe on IR and dorsiflexed
      • Ankle elevated
      • Ball of foot forms 1° angle to IR
    • Holly Method:
      • Seated position with medial border of foot 1° to IR
      • Plantar surface on IR
      • Flex the toes and place a strip of gauze over them
    • Tangential Projection: Causton Method:
      • Lateral recumbent position with unaffected side up
      • Flex knees with limb partially extended
      • Foot in lateral position
      • 1st MTP joint on IR
      • 40° prominence toward the 1st MP
    • Occlusal Film Technique:
      • Used to improve detail in sesamoid bone imaging

    Foot Projections

    • AP or AP axial Projection:
      • Supine position with knee flexed and sole on IR
      • Visualizes 1st-3rd MTP joints
    • AP axial with 10° toward heel:
      • Reduces foreshortening
      • Allows for better visualization of talus, metatarsals, phalanges, TMT joints
    • CR directed 1° to MT bone:
      • For accurate positioning
    • RP: Base of 3rd MT Bone:
      • Central point of reference
    • Elongated Projection:
      • Achieved with 10° angulation
      • Reduces foreshortening for better demonstration
    • (10') axial:
      • Alternative terminology for AP axial
      • Useful for localizing foreign bodies, fractures, and general survey of the foot bones

    Lateralside Seen

    • AP oblique Projection (Medial Rotation):
      • Supine position with knee flexed
      • Plantar aspect of foot on IR
      • Medially rotate leg medially by 30°
    • Interspaces:
      • Calcaneus and Cuboid, 5th and 4th MT
      • Talus and Navicular
      • Lateral cuneiform
      • Sinus Tarci
      • Medial cuneiform and intermediate cuneiform
      • 1st and 2nd MT
    • AP oblique bones of Foot:
      • Visualizes interspaces of proximal end of bones

    Nearest seen

    • PA oblique Projection:
      • Prone position with affected foot elevated
      • Dorsal aspect of foot on IR
    • Grashey Methods:
      • Medial or lateral rotations
      • Heel medially rotated 30° for visualizing 1st and 2nd MT interspace
      • Heel laterally rotated 20° for visualizing 2nd and 3rd, 3rd and 4th, and 4th and 5th MT interspaces.
    • PA oblique Projection (Medial Rotation):
      • Lateral recumbent position with affected side down
      • Knees flexed with leg fully extended
      • A turn toward the midline in the prone position
      • Dorsum of foot on 45° foam wedge
      • Similar to AP oblique medial rotation, but lateral aspect is closer to IR

    Lateral Projection

    • Lateromedial:
      • Position with affected side up
      • Leg and foot in lateral position
      • Lateral side of foot close to IR
      • Dorsiflex foot 90° from lower leg
    • Lateromedial (Difficult to Assume):
      • Supine position with affected side up
      • LPO/RPO
      • Medial surface on IR
      • Plantar surface of foot on IR
      • Foot in lateral position
      • More routinely used
    • TRUE Lateral FOOT:
      • Visualizes 1st-3rd MT bones
      • Achieved through lateromedial positioning
      • Lateral positioning is achieved by turning the foot toward the affected side

    Bohler's Angle (a.k.a., "Tuber Angle")

    • Formed by intersection of lines A and B in the lateral ankle radiograph
    • Normal range: 20-40 degrees
    • Angles less than 20 degrees: suggestive of calcaneal fracture or posterior facet disruption

    Longitudinal Arch

    • Lateral Projection (Weight-Bearing Method):
      • Upright position with feet elevated 1 inch above the 3rd MT bone
      • IR between feet with equal weight distribution
      • Demonstrates the structural status of the longitudinal arch
      • Compares both feet for evaluation
    • Lateromedial (Standing):
      • For individual foot evaluation
    • Pes Planus (Flat Foot):
      • Weak arch
      • Demonstrated by the lateral projection
    • Pes Cavus (Abnormal Arch):
      • High arch
      • Demonstrated by the lateral projection

    FOOT weight bearing

    • AP axial Projection (Weight-bearing Method Standing):
      • Standing position with both feet against IR
      • Equal weight distribution and 10-15° angulation towards the heel
      • Feet at 3rd MT base level
      • Evaluates tibials and metatarsals
    • Hallux Valgus:
      • Most common foot deformity
      • Affects the MTP joint
      • Evaluated with AP axial weight-bearing method:
    • Lisfranc Injury:
      • Dislocation of tarsometatarsal joint
      • Evaluated with AP axial weight-bearing method
    • AP axial Projection (Weight-bearing Composite Method Standing):
      • Upright position with two exposures
      • Affected foot steps on IR
      • 1st exposure:
        • For forefoot tube
        • Unaffected foot steps backwards to prevent superimposition
      • 2nd exposure:
        • Affected foot steps forward
        • For hind foot tube
        • 25° angulation of CR
    • 15° posteriorly:
      • Angulation for composite method
    • Base of 3rd MT bone:
      • Central point of reference for composite method

    Mechanism of Lisfranc Injury

    • Medial view of the foot:
      • Demonstrates dislocation of the second metatarsal
    • Dorsal view of the foot with weight bearing:
      • Shows the ligament disruption and space between bones in Lisfranc injury
      • Demonstrates the ligament of the middle cuneiform, medial cuneiform and the affected ligaments
    • HEALTHY FOOT:
      • Visualizes the normal arrangement of bones: phalanges, metatarsals, cuneiforms, cuboid, talus, calcaneus
    • LISFRANC FOOT:
      • Demonstrates the disruption of the ligaments and the displacement of bones: phalanges, metatarsals, cuneiforms, cuboid, talus, calcaneus

    AP Projection

    • Patient lies supine.
    • Femoral condyles must be parallel to the image receptor.
    • The foot is vertical and dorsiflexed towards the image receptor.

    Lateral Projection Mediolateral

    • Patient lies supine, turned toward the affected side (RPO or LPO).
    • Patella is perpendicular to the image receptor.
    • Femoral condyles are perpendicular to the image receptor.
    • Lateral side of the leg is placed on the image receptor.

    Alternative Method

    • Patient lies supine with a cross-table horizontal central ray.
    • Image receptor is positioned between the legs on the affected side.

    AP Oblique Projection

    • Patient lies supine with the affected leg rotated 45 degrees medially or laterally for the desired oblique view.
    • Medial rotation requires turning the leg inwards.
    • Ankle and foot rest on a 45° foam wedge.

    Midshaft Medial Rotation

    • Proximal and distal tibiofibular joints show maximum interosseous space between the tibia and fibula.

    Midshaft Lateral Rotation

    • Tibia superimposes the fibula.
    • Ankle and knee joints are visible.

    Midshaft Lateral Projection

    • Demonstrates the tibia and fibula as adjacent structures.

    Long Legs - CT

    • Requires using two separate images.
    • The unexposed area of the leg is covered with lead shielding.

    Lateral Projection

    • Demonstrates the patella and femoral condyles.

    Fibula Position

    • The fibula is located about 1 cm posterior to the tibia.

    Leg Projection

    • AP Projection: Patient lies supine with femoral condyles parallel to the image receptor (IR). The foot is vertical and dorsiflexed to the IR.
    • Lateral Projection (Mediolateral): Patient lies supine and turns towards the affected side, achieving either right or left posterior oblique (RPO/LPO) position. The patella is perpendicular to the IR, and femoral condyles are parallel to the IR. The lateral side of the leg is placed on the IR.
    • Alternative Method (for patients unable to turn): Utilize a cross-table technique with a horizontal central ray (CR). Position the IR between the legs, with the right or left posterior side of the leg resting on the IR depending on the affected side.
    • AP Oblique Projection: Patient lies supine and rotates the leg 45° medially or laterally. For medial rotation, turn the leg inward. The foot and ankle should rest on a 45° foam wedge.

    Midshaft

    • Medial Rotation (Tibia and Fibula): Maximize the interosseous space between the tibia and fibula at the proximal and distal tibiofibular joints.
    • Lateral Rotation (Tibia and Fibula): The tibia superimposes the fibula. Identify adjacent joint spaces at the ankle and knee.
    • Lateral Projection Advantages (Tibia and Fibula): Visualize the tibia and fibula in close proximity to their adjacent joint spaces.

    Long Legs: Computed Tomography (CT)

    • Requires two separate images for complete visualization.
    • Shield the unexposed portion of the patient with lead.

    Anatomy and Positioning:

    • Lateral Projection: Features include the patella and femoral condyles.
    • Fibula Positioning: The fibula is positioned approximately 1 cm posterior to the tibia.
    • AP Oblique Projections: Specific projections are used to visualize fixation devices.

    Tibia and Fibula Projections

    • AP Projection: Patient supine with femoral condyles parallel to the image receptor (IR). Foot is vertical, dorsiflexed.
    • Lateral Projection Mediolateral: Patient supine, turned towards the affected side (RPO/LPO). Patella and femoral condyles are parallel to the IR. Lateral side of the leg is placed on the IR.
    • Alternative Lateral (if patient cannot turn): Cross-table, horizontal central ray (CR). IR placed between the legs, with the affected side lateral.
    • AP Oblique Projection: Patient supine, leg rotated 45° medially or laterally. For medial rotation, turn the leg inwards; for lateral rotation, turn the leg outwards. Rest the foot and ankle on a 45° foam wedge.

    Tibia and Fibula Midshaft

    • Medial Rotation: Proximal and distal tibiofibular joints are maximally separated.
    • Lateral Rotation: Tibia and fibula are superimposed.

    Long Legs: Computed Tomography (CT)

    • Use two separate images to capture the entire length.
    • Shield the unexposed portion with lead.

    Anatomy

    • Fibula: Located 1cm posterior to the tibia.
    • Lateral Projection (Fig. 6-129): Demonstrates the patella and femoral condyles.
    • AP Oblique (medial rotation): Shows fixation devices (Fig. 6-133).
    • AP Oblique (lateral rotation): Demonstrates fixation devices (Fig. 6-134).

    Leg Projection

    • AP Projection: Patient supine with femoral condyles parallel to the image receptor (IR). Foot is vertical and dorsiflexed to IR.
    • Lateral Projection Mediolateral: Patient supine, rotated towards affected side (RPO/LPO). Patella and femoral condyles are parallel to IR. Lateral side placed on IR.
    • Alternative Method (when patient can't turn): Cross-table horizontal central ray (CR), IR placed between legs with the affected side on the IR.
    • AP Oblique Projection: Patient supine, leg rotated 45° medially or laterally. Medial rotation: turn leg inward; lateral rotation: turn leg outward. Rest foot and ankle on a 45° foam wedge.

    Midshaft

    • Medial Rotation: Proximal and distal tibiofibular joints show maximum interosseous space between tibia and fibula.
    • Lateral Rotation: Tibia superimposes fibula; ankle and knee joints are seen.
    • Lateral Projection: Tibia and fibula are adjacent.

    Long Legs - Computed Tomography (CT)

    • Two separate images used.
    • Unexposed areas covered with lead.

    Lateral Projection Details

    • Includes visualization of patella and femoral condyles.

    Anatomical Considerations

    • Fibula is located 1 cm posterior to tibia.

    AP Projection

    • Patient Supine;
    • Femoral condyles parallel to Image Receptor (IR)
    • Foot is vertical (Dorsiflexed) and perpendicular to IR, and medial malleolus is closest to IR

    Lateral Projection Mediolateral

    • Patient supine and turned on affected side using Right Posterior Oblique (RPO) or Left Posterior Oblique (LPO) position
    • Patella is parallel to IR
    • Femoral condyles are parallel to IR
    • Lateral side of leg is closest to IR with Fibula closest to IR (Fibula should not be superimposed by Tibia)

    Alternative Method - Lateral Projection (For patient that cannot turn)

    • Patient supine, place IR between patient's legs, with leg closest to IR rotated laterally so that the lateral side is on the IR
    • Cross-table technique, horizontal CR

    AP Oblique Projection

    • Patient Supine, leg is rotated 45° medial or lateral
    • Patient rotates leg medially - turn leg inward (medial side)
    • Patient rotates leg laterally - turn leg outward (Lateral side)
    • Rest the foot and ankle on a 45° foam wedge

    Midshaft - Medial Rotation

    • Proximal and distal tibiofibular joints - maximum interosseous space between Tibia and Fibula

    Midshaft- Lateral Rotation

    • Tibia superimposed over Fibula, ankle, and knee joints
    • Advantages - Tibia and Fibula are adjacent joints to make identifying fracture easier

    Long Legs - Computed Tomography (CT)

    • Use 2 separate images to achieve a complete image of the entire leg
    • Cover the unexposed portion with lead

    Lateral Projection

    • Patella visualized
    • Femoral condyles visualized

    Fibula

    • Fibula is located 1cm posterior to the Tibia

    Tibia and Fibula Projections

    • AP Projection: Patient supine, femoral condyles parallel to IR, foot vertical and dorsiflexed.
    • Lateral Projection: Patient supine, rotated toward affected side (RPO/LPO), patella and femoral condyles parallel to IR, lateral side placed on IR.
    • Alternative Lateral Projection: Patient supine, cross-table, horizontal CR, IR placed between legs with affected side lateral.
    • AP Oblique Projection: Patient supine, leg rotated 45° medially or laterally. Medial rotation: Turn leg inward. Lateral Rotation: Turn leg outward. Rest foot and ankle on 45° foam wedge.

    Tibia and Fibula Positioning

    • Midshaft Medial Rotation: Maximum interosseous space between tibia and fibula.
    • Midshaft Lateral Rotation: Tibia superimposes fibula.
    • Lateral Projection of Midshaft: Tibia and fibula are adjacent.

    Imaging Considerations

    • Long Leg CT: Utilize two separate images, use lead to shield the unexposed portion.
    • Lateral Projection: Patella and femoral condyles should be visualized.
    • Fibula Location: The fibula is approximately 1 cm posterior to the tibia.

    PA Projection

    • Patient lies prone
    • Patella is parallel to imaging receptor
    • Heel rotated 5° to 10° laterally
    • The mid-popliteal depression is used for positioning
    • There is a void in the image
    • Patella is superimposed by the femur
    • Bipartite patella is visible as a radiolucent line
    • This is not a fracture

    Lateral Projection: Medio-Lateral

    • Patient lies on their side
    • Knee flexed 5° to 10°
    • Patella is perpendicular to the image receptor
    • Epicondyles are superimposed
    • A lateral projection shows the patellofemoral joint open

    PA Oblique Projection: Medial Rotation

    • Patient lies prone
    • Knee flexed 5° to 10°
    • Medial rotation of 45-55° to visualize the medial portion of the patella free of the femur

    PA Oblique Projection: Lateral Rotation

    • Patient lies prone
    • Knee flexed 5° to 10°
    • Knee laterally rotated 45° to 55°
    • Lateral portion of the patella is free of the femur.

    KUCHENDORF method: PA axial oblique Projection: Lateral Rotation

    • Patient lies prone
    • Hip is elevated 2-3 inches
    • Knee is flexed 10°
    • Knee laterally rotated 35-40°
    • 25° to 30° caudad angulation
    • Patellofemoral joint space between the two femoral condyles
    • Most of the patella is free of the femur except for the patellar outline
    • Thumb placed on patella for lateral displacement

    Hughston method: Tangential Projection (Jaroschy)

    • Patient lies prone
    • Knee on the image receptor
    • Knee flexed 50° to 60°
    • 45° cephalic angulation
    • Tangential image of the patellofemoral joint
    • Used for assessment of subluxation of the patella and patellar fractures

    Hughston (55°)

    • Both knees examined side-by-side for comparison

    Laurin method

    • Knee flexed 20°
    • Assesses patellar subluxation

    Fodor-Malott & Weinberg, Merchant et al

    • 45° knee flexion

    Merchant Method: Tangential Projection - Bilateral

    • Patient lies supine
    • Both knees flexed 40-45°
    • Knee elevated 2° (femora parallel to tabletop)
    • 30 ° caudad angulation from horizontal plane
    • Open patellofemoral joint
    • Patella non-distorted and slightly magnified

    Patella Projections

    • PA Projection:
      • Patient is prone with the knee extended and the patella parallel to the image receptor.
      • Heel is rotated laterally 5 to 10 degrees.
      • Center the beam on the midpopliteal depression to obtain sharper detail and avoid superimposition of the patella by the femur.
      • A radiolucent line on the x-ray or CT scan may indicate a bipartite patella, which is a normal variant and not a fracture.
    • Lateral Projection (Medio-lateral):
      • Patient is in a lateral recumbent position with the knee flexed at 5-10 degrees.
      • This angle minimizes the patellofemoral joint space, helpful for evaluating patellar injuries.
      • Flexing the knee greater than 10 degrees may be necessary for unhealed or new patellar fractures.
      • The patella should be internally rotated and the epicondyles superimposed.
      • This projection allows visualization of the patellofemoral joint space, with the patella and patellofemoral joint being open.
    • PA Oblique Projection (Medial Rotation):
      • Patient is prone with the knee flexed 5 to 10 degrees and medially rotated 45-55 degrees.
      • This projection allows the medial portion of the patella to be visualized free from the femur.
    • PA Oblique Projection (Lateral Rotation):
      • Patient is prone with the knee flexed 5 to 10 degrees and laterally rotated.
      • This projection allows the lateral portion of the patella to be visualized free from the femur.
    • KUCHENDORF Method (PA Axial Oblique Projection: Lateral Rotation):
      • Patient is prone with the hip elevated 2-3 inches and the knee flexed 10 degrees.
      • Knee is laterally rotated 35-40 degrees.
      • The beam is angled 25-30 degrees caudad.
      • This method allows for visualization of the joint space between the patella and the femoral condyles while keeping the majority of the patella free from the femur.
      • This position can be uncomfortable for the patient; a finger may be used to assist in laterally displacing the patella.

    Patella & Patellofemoral Joint Projections

    • Hughston Method (Tangential Projection, Jaroschy):
      • Patient is prone with the knee flexed 50-60 degrees and resting on the image receptor.
      • The foot is placed on the collimator.
      • The beam is angled 45 degrees.
      • This projection provides a tangential image of the patellofemoral joint, useful for assessing subluxation of the patella and patellar fractures, as well as the femoral condyles.
      • It also allows for visualization of bony detail of the patella and femoral condyles.
    • Hughston (55°):
      • This method is utilized to compare both knees for symmetry.
    • Laurin Method:
      • Patient's knee is flexed 20 degrees.
      • This projection is used to assess patellar subluxation.
    • Fodor-Malott & Weinberg wl Merchant et al.:
      • Patient's knee is flexed 45 degrees.
    • Merchant Method (Tangential Projection - Bilateral):
      • Patient is supine with both knees flexed 40-45 degrees.
      • The beam is angled 30 degrees caudad from the horizontal plane.
      • This method uses a skyline or "sunrise" projection to visualize the patellofemoral joint in an open position, minimizing distortion and slightly magnifying the patella.
      • It can be utilized for various patellofemoral disorders.

    Studying That Suits You

    Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

    Quiz Team

    Related Documents

    Foot Projections P2 (1) PDF
    Foot Projections PDF
    Leg Projections PDF
    Patella and PF Joint Projections PDF

    Description

    Test your understanding of key details from a document by answering questions about its date, time, content description, project focus, and document format features. Each question is designed to help you analyze and interpret the structure and information presented.

    More Quizzes Like This

    Mastering Vision and Scope Documents
    3 questions

    Mastering Vision and Scope Documents

    ExaltingHarmony avatar
    ExaltingHarmony
    Data Migration Backlog Items
    4 questions

    Data Migration Backlog Items

    UserReplaceableHeliotrope9188 avatar
    UserReplaceableHeliotrope9188
    Forensics Chapter 16 Quiz: Document Analysis
    30 questions

    Forensics Chapter 16 Quiz: Document Analysis

    QuietRubidium avatar
    QuietRubidium
    Document Criticism and Analysis Methods
    39 questions

    Document Criticism and Analysis Methods

    BountifulLapSteelGuitar avatar
    BountifulLapSteelGuitar
    Use Quizgecko on...
    Browser
    Open
    Browser
    Browser