Foot Projections PDF

# Foot Projections ## Toes Projection - **AP or APaxial Projections:** - Seated/supine - Knees flexed - AP: 15" foam wedge - Aparial: 15" posteriorly - **PA Projection:** - Prone; - Dorsal aspect of foot on IR; - IR parallel to 18° **All CR 1; 3rd MTP joint** * **Patial CR:...

# Foot Projections ## Toes Projection - **AP or APaxial Projections:** - Seated/supine - Knees flexed - AP: 15" foam wedge - Aparial: 15" posteriorly - **PA Projection:** - Prone; - Dorsal aspect of foot on IR; - IR parallel to 18° **All CR 1; 3rd MTP joint** * **Patial CR: 15°** - Phalanges - Distal Metatarsal * **Apaxial: Open** - Interphalangeal Jt (IP Jt) - Reduce foreshortening * **Aarial CR: 15°** - 1st - 3rd MTP Jt - Well visualized of IP Jts spaces - Sesamoid bone of 1st Metatarsal * **Medial Rotation** - AP oblique Projection - Supine/Seated - Flex the knee - Lower leg/foot medially rotate - 30-45° From IR - Plantar on IR * **Lateral Rotation** - 3rd - 5th lateral oblique toes - MTP Jts overlaped * **PA oblique Projection** - Lateral recumbent on affected side - Partial extended affected limb - Base of foot forms 30° to horizontal (PT toward prone) * **Lateral** - Lateromedial/Mediolateral - Great toe, 2nd toe in true Lateral; - Lateral recumbent (unaffected side) * **To prevent superimposition:** - Tape or place gauze above the one being examined/ - Occlusal film/stick * **Mediolateral** - 3rd, 4th, 5th toes (affected side) * **3rd open 2nd to 5th MTP joint** - MTP Jt spaces - Oblique toes * **1st MTP Jt not always open** * **Apo Pros (medial not)** * **Proproy (medial not)** - Open 2nd - 5th MTP joint space * **Other toes:** - PIP jt * **Lateral** - Lateromedial: 1st & 2nd toes * **Mediolateral:** - 3rd, 4th, 5th toes - Open IP Jts spaces * **True Lateral** ___ ## Sesamoids Projections ### Tangential Projection: * **Lewis Method** - Prone; - Great toe on IR, Dorsiflex; - Ankle elevated; - Ball of foot 1 to IR - Sesamoid bone - 1st MT head * **Holly Method** - Seated (more comfy) - Medial border of foot 1 to IR - Plantar surface to IR - The Flexed; PT hold toes with a strip of gauze - 1st MT head - Tarsal sesamoid bone * **Tangential Projection: Causton Method** - Lateral recumbent (unaffected side) - Flex the knees; - Limb Partially extended - Foot in lateral position - MTP jt 1 to IR - 40° prominence toward of the 1st MIP - Tarsal sesamoid bone - Axiolaterally with slight overlap * **Occlusal film technique:** - For improve detail ___ ## Foot Projection - **AP or AP axial Projection:** - Supine; - Flex the knee; - Sole on IR; - 1st - 3rd MTP Jt - **AP axial: 10° toward the heel** - **CR is Directed 1 to MT bone** - **RP: Base of 3rd MT Bone** - **Elongated (10° angulation):** - Reduces foreshortening - Talus - Metatarsals - Phalanges - TMT Jt - Better demo - **(10') axial** - **FOR:** - For localizing Foreign bodies. - Location of fragments in FX of MT 7 anterior - General survey of the bones of foot. ___ ## Lateralside Seen - **AP oblique Projection medial rotation:** - Supine - Flex the knee - Plantar on IR - Rotate leg medially; Plantar 30° to IR ### Farthest Seen - Not ≥30: Lateral cuneiform be thrown over other cuneiform in Profile - Greater angulation = open MTP spaces - **Interspace b/n:** - Calcaneus? - Cuboid 5th? 4th MT - Talus? Navicular - Lateral cuneiform - Sinus Tarci * **Medial part seen** - **Interspace b/n:** - 1st & 2nd MT - Medial ? Intermediate cuneiform - navicular in Profile - **AP oblique bones of Foot** - Interspaces of Proximal end ___ ## Nearest seen - **PA oblique Projection** - Prone; - Affected foot elevated; - dorsal of foot on IR - **Grashey Methods** - **Medial or Lateral rotations** - Heel Medially rotated 30° - Interspace b/n 1st & 2nd MT - Heel Laterally rotated 20° - Interspace b/n 2nd & 3rd MT - 3rd & 4th MT - 4th 5th MT - **PA oblique Projection Medial rotation** - Lateral recumbent (affected side) - Knees Flex; - Leg fully extend - A turn toward midline prone - Dorsum on 45° foam wedge - Same as the AP oblique of foot medial rot- - Lateral aspect closer to IR - More oblique than Grachey ___ ## Lateral Projection - **Latero medial** - Turn toward the affected side - Leg and foot lateral position - Lateral side of foot close to IR - Dorsiflex foot 90° from lower leg * **More routinely (use)** - **Latero medial (difficult to assume)** - Supine - LPO/RPO - Affected side up - medial surface on IR - Plantar surface of foot IR - Foot Lateral position - **TRUE Lateral FOOT** - 1st - 3rd MT bone - **True Lateral of Foot** - **Is achieved** - **Lateromedial** - Medial - Lateral ### Bohler's Angle (a.k.a., "Tuber Angle") - Bohler's angle (sometimes referred to as the "Tuber Angle") is formed by the intersection of lines A and B in the lateral ankle radiograph - The normal range is 20 to 40 degrees. - Angles <20 degrees is suggestive of a calcaneal fracture or disruption of the posterior facet ### Longitudinal Arch - **Lateral Projection Weight-Bearing method** - Upright; - Feet elevated 1 above (horizontal) the 3rd MT bone - IR b/n Feet; - Weight equally distributed on each foot - Loteromedial of bones of foot - Both feet are examined for comparison - **Lateromedial (Standing)** - Per Foot **Demonstrate:** - Structural status of the Longitudinal arch - **(pes planus) Flat foot:** - No arch; weak - **(pes cavus) abnormal arch** ### FOOT weight bearing - **AP axial Projection Weight-bearing method Standing** - Standing; - Both feet against IR; - Weight equally distributed on each foot. - 10-15° toward the hoel - Feet at 3rd MT base level - Accurate evaluation in comparison of the ticals and metatarsals - **Demo of: Hallux valgus** - Most Common foot deformity - MTP It affected - **Lisfranc injury** - Dislocation of tarsometatarsal jt - **AP axial Projection Weight-bearing Composite Method Standing** - Upright - 2 exposures - Affected foot step on IR - 1st exposure: - For Forefoot tube - Unaffected foot step backward - (Prevent the MT & Phalanges) Superimposition of leg shadow - **1st exposure:** - Unaffected foot: - For Hind foot tube back exposure anterior - 25° angulation CR of 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 second metatarsal (distal first) - dislocation of the second metatarsal * **Dorsal view of the foot with weight bearing** - Normal position of the second 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