Podcast
Questions and Answers
Which bones articulate with the talus?
Which bones articulate with the talus?
Which cuneiform is the largest and articulates with the 1st metatarsal?
Which cuneiform is the largest and articulates with the 1st metatarsal?
What is the primary function of the arches of the foot?
What is the primary function of the arches of the foot?
Where is the transverse arch located?
Where is the transverse arch located?
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Which bones are located distally in relation to the calcaneus?
Which bones are located distally in relation to the calcaneus?
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What is the primary function of dorsiflexion in the foot?
What is the primary function of dorsiflexion in the foot?
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When performing radiographic positioning, what should be considered regarding the long axis of the part?
When performing radiographic positioning, what should be considered regarding the long axis of the part?
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In what situation should extra caution be taken for geriatric patients?
In what situation should extra caution be taken for geriatric patients?
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What is gout characterized by in the body?
What is gout characterized by in the body?
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What is the purpose of collimation in radiographic procedures?
What is the purpose of collimation in radiographic procedures?
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Which structure is referred to as the largest and strongest bone in the foot?
Which structure is referred to as the largest and strongest bone in the foot?
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What is the primary role of the sustentaculum in the lower extremity?
What is the primary role of the sustentaculum in the lower extremity?
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Which of the following tarsal bones articulates with the cuboid anteriorly?
Which of the following tarsal bones articulates with the cuboid anteriorly?
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How many phalanges are found in the foot?
How many phalanges are found in the foot?
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Which projection is typically used to visualize the peroneal trochlea?
Which projection is typically used to visualize the peroneal trochlea?
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What is the primary function of the sinus tarsi in the foot?
What is the primary function of the sinus tarsi in the foot?
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Which part of the calcaneus is a common site for bone spurs?
Which part of the calcaneus is a common site for bone spurs?
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Which of the following statements is true regarding the articular facets of the subtalar joint?
Which of the following statements is true regarding the articular facets of the subtalar joint?
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What is the central ray location for the AP view of the feet?
What is the central ray location for the AP view of the feet?
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Which angle is used for the central ray during an AP foot setup?
Which angle is used for the central ray during an AP foot setup?
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What is the function of dorsiflexing the foot in foot positioning?
What is the function of dorsiflexing the foot in foot positioning?
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Which of the following describes the location of the navicular bone?
Which of the following describes the location of the navicular bone?
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What is the other name commonly used for the calcaneus?
What is the other name commonly used for the calcaneus?
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Which joint is formed between the talus and calcaneus?
Which joint is formed between the talus and calcaneus?
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How are the cuneiform bones named?
How are the cuneiform bones named?
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Which bones does the cuboid articulate with?
Which bones does the cuboid articulate with?
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When performing a mediolateral projection for the 4th and 5th digits, how should the foot be rotated?
When performing a mediolateral projection for the 4th and 5th digits, how should the foot be rotated?
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What should the CR be directed to when taking an AP view of the toes?
What should the CR be directed to when taking an AP view of the toes?
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What is the purpose of rotating the foot differently for the 1-3 digits compared to the 4-5 digits?
What is the purpose of rotating the foot differently for the 1-3 digits compared to the 4-5 digits?
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What is the CR angle for the lateral view of the foot?
What is the CR angle for the lateral view of the foot?
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In the tangential projection for the sesamoids, how should the patient be positioned?
In the tangential projection for the sesamoids, how should the patient be positioned?
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What must be done to the unaffected toes during the lateral or mediolateral projections?
What must be done to the unaffected toes during the lateral or mediolateral projections?
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For a high arched foot, what angle should the CR be set to during an AP view?
For a high arched foot, what angle should the CR be set to during an AP view?
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Study Notes
Lower Extremity Anatomy
- There are 26 bones in the foot
- There are 7 tarsal bones
- Calcaneus: Largest tarsal bone, AKA os calcis. Posterior & inferior portion has a tuberosity, common site for bone spurs, Achilles tendon attaches.
- Lateral process: Larger process
- Medial process: Smaller & less pronounced
- Talus: AKA astragalus. Second largest - Articulates with tibia, fibula, calcaneus, and navicular.
- Peroneal trochlea (trochlear process): Visualized laterally on an axial view
- Sustentaculum: Located on medial proximal aspect of calcaneus, meaning “support for the talus”
- Navicular: AKA scaphoid. Located on medial side of foot between talus and 3 cuneiforms
- Cuboid: Located on lateral aspect of foot, distal to calcaneus and proximal to 4th & 5th metatarsals.
- Cuneiforms:
- Medial (1st): Largest, articulates with 1st metatarsal
- Intermediate (2nd): Smallest, articulates with 2nd metatarsal
- Lateral (3rd): Articulates with 3rd metatarsal and cuboid
- Tibial and fibular sesamoid bones: extra bones embedded in tendons
- Arches provide strong, shock-absorbing support.
- Longitudinal Arch: Medial and Lateral
- Transverse Arch: Distal tarsals, tarsometatarsal joints - Primarily cuneiforms and cuboid
Radiographic Positioning Considerations
- Distance: 40 SID
- Shielding: Sensitive organs
- Collimation: To all four sides without cutting off essential anatomy
- Positioning: Long axis of part parallel to long axis of IR
- Grids: Greater than 10 cm
- Pediatric: Allow parents to help, most exams same as adults
- Geriatric: Handle carefully, check for hip fracture (foot in extreme external rotation)
- Cast conversions: Cast materials can affect density of the image
- Clinical Indications: Fractures and dislocations, Gout (Especially 1st digit)
Positioning - Toes
- Routine Views: AP, Oblique, Lateral
- Special Views: Sesamoids (tangential)
- AP Projection:
- Knee flexed with plantar surface of foot resting on IR.
- CR 10-15˚ toward calcaneus.
- CR at MTP joint in question
- Collimation: Include one digit on each side of affected digit, minimum distal half of metatarsal
- Oblique Projection:
- Knee flexed with plantar surface of foot resting on IR.
- Rotate foot 45˚ medial for 1st-3rd digits.
- Rotate 30˚ laterally for 4th-5th digits.
- CR perpendicular to IR directed at MTP joint in question
- Lateral Projection:
- Rotate leg and foot medially (1st-3rd digits) or laterally (4th-5th digits).
- Use tape, gauze, or tongue blade to separate unaffected toes to prevent superimposition
- Sesamoid (tangential) Projection:
- Patient prone with foot dorsiflexed.
- Plantar surface of foot should form 15-20˚ angle with vertical.
- Great toe dorsiflexed and resting on IR.
- CR perpendicular to IR directed at 1st MTP joint.
Positioning - Foot
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Routine Views: AP, Oblique, Lateral,
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Special Views: Weight-Bearing AP, Lateral
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AP Projection:
- Plantar surface on IR.
- CR 10˚ posteriorly toward heel.
- CR perpendicular to metatarsals.
- CR directed at base of 3rd metatarsal.
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Oblique Projection:
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Plantar surface on IR.
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Medially rotate foot 30-40˚.
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Dorsum aspect of foot should be parallel to IR.
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CR perpendicular to IR directed at base of 3rd metatarsal.
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Lateral Projection:
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Dorsiflex foot to place in true lateral.
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Plantar surface perpendicular to IR.
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CR at medial cuneiform (level of base of 3rd metatarsal).
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Collimation: Include about 1 inch above ankle joint
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Weight-Bearing Views:
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AP Weight-Bearing:
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Patient stands with full weight evenly distributed.
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Feet straight ahead and parallel to each other.
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CR 15˚ posteriorly.
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CR midpoint between feet at level of base of metatarsals.
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Lateral Weight-Bearing:
- Patient stands with weight on affected foot.
- Hold onto something for support.
- CR horizontally directed at base of 3rd metatarsal.
Foot & Ankle Joint Motions
- Dorsiflexion: Bending upward towards the shin
- Plantar Flexion: Bending downward towards the ground
- Inversion (Varus): Turning inward, making medial side of the foot face upward
- Eversion (Valgus): Turning outward, making lateral side of the foot face upward
Conditions/Pathology
- Fractures: Breaks in the structure of bone caused by force.
- Gout: Form of arthritis that may be hereditary, where uric acid deposits in joints & tissues. (Common initial attacks in the 1st MTP joint of the foot)
- Joint effusions: Accumulated fluid in the joint cavity (example: plural effusion is fluid in the lungs)
Quiz Questions:
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How many bones are located in each foot? 26
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How many tarsal bones do we have? 7
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What are the names of each of the tarsal bones? Calcaneus, Talus, Navicular, Cuboid, Medial Cuneiform, Intermediate Cuneiform, Lateral Cuneiform.
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Can you find them on the x-rays (AP, Oblique, and Lateral)?
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Which of the tarsal bones is the largest? Calcaneus
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What is the other name for Calcaneus? Os Calcis
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What is the common site for bone spurs in the heel? Tuberosity of Calcaneus
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What attaches at this location? Achilles Tendon
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What are the two bumps on the calcaneus called that we can see on the upper portion of the axial view? Lateral process and Medial Process.
- Which one is medial? Medial Process
- Which is lateral? Lateral Process
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What two bones does the calcaneus articulate with? Talus and Cuboid
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What is the other name for talus? Astragalus
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What joint is formed between the talus and calcaneus? Subtalar joint (talo-calcaneal joint)
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What is located between the depression of the talus and calcaneal sulcus for ligaments to pass through? Sinus Tarsi (tarsal sinus)
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What bones does the talus articulate with? Tibia, Fibula, Calcaneus, Navicular.
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Which of the tarsal bones is flat and oval, located on the medial side of the foot? Navicular.
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What bones does the navicular articulate with? Talus, 3 cuneiforms, Cuboid
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Where is the cuboid located? Lateral aspect of the foot
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Which bones does the cuboid articulate with? Calcaneus, lateral cuneiform, navicular, 4th & 5th metatarsals.
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What are the names of the 3 cuneiforms? Medial (1st), Intermediate (2nd), Lateral (3rd)
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What does each one articulate with? Medial: First metatarsal, Intermediate: 2nd metatarsal, Lateral: 3rd metatarsal & Cuboid
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What bone do they all articulate with? Navicular
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What are the names of the two small bones located on the 1st metatarsal? Tibial & Fibular sesamoid bones.
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Can you label all of the joints on slide 19 on each x-ray? Intertarsal, TMT (Tarsometatarsal), MTP (Metatarsophalangeal), PIP (Proximal interphalangeal), DIP (Distal interphalangeal), IP (Interphalangeal).
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Define dorsiflexion: Bending upward towards the shin.
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Define plantar flexion: Bending downward towards the ground.
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Define Inversion (varus): Turning inward, making the medial side of the foot face upward.
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Define Eversion (valgus): Turning outward, making the lateral side of the foot face upward.
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What are your cast conversions?
- Small to medium plaster: 1/4” lead
- Large plaster: 1/2” lead
- Fiberglass: No metal required; lead is usually not needed
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Define Gout: Form of arthritis that may be hereditary, where uric acid deposits in joints & tissues. (Common initial attacks in the 1st MTP joint of the foot)
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Define Joint effusion: Accumulated fluid in the joint cavity (example: pleural effusion is fluid in the lungs).
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How is the CR angled for an AP view of the toes? 10-15 degrees towards the calcaneus
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Where is the CR located for AP toes? Centered on the MTP joint in question.
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Description
Test your knowledge on the anatomy of the lower extremity, specifically focusing on the bones of the foot. This quiz covers key details about the tarsal bones, including their locations and functions. Perfect for students studying anatomy or professionals in the medical field.
