Foot Anatomy and X-ray Preparation

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Questions and Answers

What can apophysis be mistaken for in children?

Fracture (correct)

Osteosarcoma

Sprain

Tendinopathy

Which injury is characterized by torn ligaments or broken bones in the mid foot area?

Metatarsal fracture

Lisfranc fracture (correct)

Calcaneal fracture

Osteoarthritis

What common joint changes occur in rheumatoid arthritis of the foot?

Cysts in the heel pad

Increased density in metatarsal bones

Deterioration of the ankle joint

Similar radiographic appearance as seen in the hands (correct)

Which condition is primarily caused by the wearing out of smooth cartilage joint surfaces?

Osteoarthritis Signup and view all the answers

In assessing calcaneal fractures using radiography, which projection is most commonly utilized?

Lateral projection Signup and view all the answers

What is the characteristic feature of osteoarthritis in terms of joint involvement?

It usually begins in an isolated joint. Signup and view all the answers

What is a common radiographic finding in the acute phase of gout?

Extrinsic periarticular bony erosions. Signup and view all the answers

Which of the following is NOT a risk factor for plantar fasciitis?

Frequent walking on tiptoes Signup and view all the answers

What is a primary diagnostic method for determining pes planus?

Bilateral AP & lateral weight-bearing feet views. Signup and view all the answers

Which demographic is most commonly affected by hallux valgus deformity?

Women. Signup and view all the answers

Which imaging technique is most suitable for visualizing soft tissue structures in foot imaging?

MRI. Signup and view all the answers

What anatomical change is observed in pes planus?

Longitudinal arch reduced. Signup and view all the answers

What specific radiographic view is commonly used to evaluate hallux valgus?

Bilateral AP weight-bearing views. Signup and view all the answers

Which bones are part of the midfoot section of the foot anatomy?

Navicular, Cuboid and Cuneiforms Signup and view all the answers

What is the purpose of the AP weight bearing projection?

To assess alignment of metatarsals and phalanges Signup and view all the answers

What is a key evaluation criterion for the axial calcaneus radiograph?

Talocalcaneal joint space is open Signup and view all the answers

When positioning for a lateral calcaneus radiography, what is the recommended central ray placement?

2.5cm distal to the medial malleolus Signup and view all the answers

Which factor is crucial for optimal visualization of bone and soft tissue in foot imaging?

Ensuring no motion during exposure Signup and view all the answers

In evaluating lateral foot radiographs, what appearance should the metatarsals exhibit?

Nearly superimposed Signup and view all the answers

What angle should the central ray be directed for the axial calcaneus view?

40 degrees cephalic Signup and view all the answers

Which is NOT included in the evaluation criteria for AP oblique foot radiographs?

Presence of artifacts or foreign objects Signup and view all the answers

What should be done to reduce superimposition when imaging the lateral 1st or 2nd toe?

Place the medial side of the toe onto the image receptor Signup and view all the answers

In the lateral projection of the foot, how should the ankle be positioned?

Flexed to 90 degrees Signup and view all the answers

What anatomical structures are evaluated in the axial calcaneus view?

Talocalcaneal joint and entire calcaneus Signup and view all the answers

When performing AP toes radiography, what should be done with the toes if the patient cannot uncurl them?

Use an angle of 15 degrees to the image receptor Signup and view all the answers

What should be included in the collimation for an AP foot image?

Four sides to the outer margins of the foot Signup and view all the answers

When viewing a lateral foot x-ray, what indicates a true lateral position?

Concave appearance of the anterior surface of the phalanges Signup and view all the answers

Study Notes

Foot Anatomy

The foot has 26 bones
The foot is divided into three sections: Forefoot, Midfoot, and Hindfoot
Forefoot: Metatarsals & Phalanges
Midfoot: Navicular, Cuboid & Medial, Intermediate and lateral Cuneiforms
Hindfoot: Calcaneus & Talus
Joints in the foot include: DIP, PIP, MTP, TMT, and Subtalar Joint
The subtalar joint is between the Talus and the Calcaneus

Foot Movements

Medial rotation: Rotation of the foot inwards
Lateral rotation: Rotation of the foot outwards
Dorsiflexion: Bending the foot upwards
Plantarflexion: Bending the foot downwards

The Toes

Indications for an x-ray of the toes may include: Trauma, Cuts, Pain, Bruising, Lumps, Loss of function, Foreign Body, Deformity, Swelling, Reduced Range of Movement, and Infections

Preparation for X-ray of Toes

Patient identification check
Pregnancy check if applicable
Patient must remove shoes, socks and jewelry
Patient to sit or lay on the xray table
Patient must wear lead apron for radiation protection

AP Toe X-ray

kVp: 52 kVp
mAs: 2.5 mAs
FFD: 100-110 cm
CR: Center to the MTP joint of interest
Patient Position: Pt sitting or supine on table with legs extended. Flex knee so the foot of interest is flat on the image receptor. Uncurl toes if possible. If Pt can't uncurl toes an angle of 15 degrees may be used.
Collimation: To include a digit either side of the digit of interest. Include all distal phalanx and distal metatarsal.

AP Oblique Toe X-ray

kVp: 52 kVp
mAs: 2.5 mAs
FFD: 100-110 cm
CR: Center to the MTP joint of interest
Patient Position: Pt sitting or supine on table with legs extended. Flex knee so the foot of interest is flat on the image receptor. Uncurl toes if possible. Rotate foot 45 degrees medially. A radiographic positioning sponge may be added for support.
Collimation: To include a digit either side of the digit of interest. Include all distal phalanx and distal metatarsal.

Lateral 1st or 2nd Toe X-ray

kVp: 52 kVp
mAs: 2.5 mAs
FFD: 100-110 cm
CR: Center to the MTP joint of the 1st or 2nd toe
Patient Position: Pt to lie on their unaffected lateral side. Place the medial side of the 1st toe onto the image receptor. Tape other toes out of the way to reduce superimposition.
Collimation: Include all distal phalanx and distal metatarsal

Lateral 3rd, 4th, and 5th Toe X-ray

kVp: 52 kVp
mAs: 2.5 mAs
FFD: 100-110 cm
CR: Center to the MTP joint of the 3rd, 4th or 5th toe
Patient Position: Pt to lie on their affected lateral side. Place the lateral side of the foot on the image receptor. Tape other toes out of the way to reduce superimposition.
Collimation: Include all distal phalanx and distal metatarsal

AP Foot X-ray

kVp: 52 kVp
mAs: 3.2 mAs
FFD: 100-110 cm
CR: Center to the base of the 3rd metatarsal
Patient Position: Pt sitting or supine on table with legs extended. Flex knee so the foot of interest is flat on the image receptor. Uncurl toes if possible. Central ray angled 10-15 degrees towards the heel
Collimation: Four sides to the outer margins of the foot (skin surface).

AP Oblique Foot X-ray

kVp: 52 kVp
mAs: 3.2 mAs
FFD: 100-110 cm
CR: Center to the base of the 3rd metatarsal
Patient Position: Pt sitting with legs extended. Flex knee so the foot of interest is flat on the image receptor. Rotate foot medially 45 degrees. Uncurl toes if possible. Immobilize with a radiographic positioning sponge. Straight central ray.
Collimation: Four sides to the outer margins of the foot (skin surface)

Lateral Foot X-ray

kVp: 55 kVp
mAs: 3.2 mAs
FFD: 100-110 cm
CR: Center to the base of the third metatarsal
Patient Position: Pt to lie on their affected lateral side. Place the lateral side of the foot on the image receptor. Dorsi flex foot to 90 degrees with ankle (where possible). Support knee with a sponge if needed.
Collimation: Four sides to the outer margins of the foot (skin surface)

Axial Calcaneus X-ray

kVp: 60 kVp
mAs: 3.2 mAs
FFD: 100-110 cm
CR: Center to the base of the 3rd metatarsal, to emerge just distal and inferior to ankle joint
Patient Position: Pt supine on table. Legs straight with ankle flexed at 90 degrees (bandage may help). Heel in contact with image receptor. Central ray angled 40 degrees cephalic angle
Collimation: Four sides to the outer margins of the calcaneus

Lateral Calcaneus X-ray

kVp: 55 kVp
mAs: 3.2 mAs
FFD: 100 cm
CR: Center 2.5 cm distal to the medial malleolus
Patient Position: Roll pt onto their affected side. Lateral aspect of the foot on the image receptor. Flex ankle to 90 degrees. Elevate knee slightly with a sponge if needed.
Collimation: Four sides to the outer margins of the calcaneus; include inferior and posterior margins of the heel and medical malleolus to base of fifth metatarsal

Weight Bearing Foot X-rays

AP and Lateral weight bearing x-rays are done to assess alignment
AP demonstrates alignment of metatarsals and phalanges
Lateral demonstrates longitudinal arch (flat feet)
Bilateral is often done for comparison

Pathology

Fractures of the toes: Jones fracture is a fracture of the base of the 5th metatarsal
Osteoarthritis: Degenerative joint disease affecting the MTP joint of the 1st toe, often seen with hallux valgus deformities
Gout: Common but complex form of arthritis that can affect anyone. Can be difficult to see in the acute stage. Extrinsic periarticular bony erosions with a distinctive lip of bone at the edge. In the late stage, joint space narrowing occurs.
Plantar Fasciitis: Common cause of heel pain. Irritated and inflamed band of tissue along the bottom of the foot (plantar fascia). Risk factors include obesity, excessive running or standing. A heel spur can be seen on x-ray.
Pes Planus (flat feet): Longitudinal arch reduced on standing. Often seen with ankles rolled in towards each other. Can be congenital or due to muscle weakness. Diagnosed via bilateral AP and lateral weight bearing foot views.
Hallux Valgus Deformity - Bunions: Bony bump that forms on the 1st toe. Lateral deviation of the 1st toe. Bilateral AP weight bearing views. More common in women.
Calcaneal Fracture
Lisfranc Fracture: Broken bones or torn ligaments in the midfoot area caused by a crush injury or twisting motion.
Rheumatoid Arthritis: Autoimmune disease that attacks the body’s joints. The same radiographic appearance as in the hands. MTP joints, particularly 5th, IP Joint 1st toe, and intertarsal joints affected.
Osteoarthritis: Wears out the smooth cartilage surface of the joint.

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Description

This quiz covers the anatomy of the foot, including bones, sections, and joint movements. Additionally, it outlines the preparation required for an X-ray of the toes, emphasizing patient safety and identification. Test your knowledge on foot anatomy and X-ray procedures.