Toes and Feet 2024 Radiographic Positioning PDF

RAD 101 References: Bontrager 10th edition Textbook of Radiographic Positioning and Related Anatomy 11th edition  Explain the anatomy and positioning of all lower extremities  Identify the following parts and prominences on an image of the lower extremity Metatarsals...

RAD 101 References: Bontrager 10th edition Textbook of Radiographic Positioning and Related Anatomy 11th edition  Explain the anatomy and positioning of all lower extremities  Identify the following parts and prominences on an image of the lower extremity Metatarsals Tarsal bones 1. Base (proximal end) 1. Calcaneus - os calcis 2. Body (shaft) 2. Talus - astragalus 3. Head (distal end) 3. Navicular - scaphoid Phalanges (Toes, Digits) 4. Cuneiforms 1. Proximal phalanx 5. Cuboid 2. Middle phalanx 3. Distal phalanx  Identify the structures best shown on routine images of the lower extremity  Describe the routine and special projections for each of the following radiographic procedures:  Toe(s)  Foot  Discuss why each of the above projections may be requested How many are in the hand?  Phalanges (14) – Most distal  Metatarsals (5) – Instep of foot  Tarsals (7) - Proximal Name for Great Toe?  Largest & strongest bone in the foot Posterior & inferior portion: Tuberosity Common site for bone spurs Achilles tendon attaches 2 processes Lateral Process - largest Medial Process – smaller/less pronounced Right Calcaneus – inferior aspect https://www.orthopaedicsone.com/download/attachments/32180545/worddav970ca59ae06f335f576983c67bfa29b3.png?version=1&modificationDate=1270514745000  Peroneal Trochlea (trochlear process)  Visualized laterally on an axial projection  Sustentaculum  Means “support for the talus”  Located on the medial proximal aspect  Articulates with 2 bones  Cuboid  Anteriorly  Talus  Superiorly  Forms the subtalar (talocalcaneal) joint  3 articular facets  Posterior (larger)  Anterior & Middle (Smaller)  Calcaneal Sulcus  Deep depression between posterior and middle   2nd largest tarsal bone  Located between lower leg and calcaneus  Weight of the body is transmitted by this bone through the ankle and talocalcaneal joints  Sinus Tarsi (tarsal sinus)  Ligaments pass through Which  opening in the subtalar joint Tarsal is the  Formed by a depression of the talus and calcaneal largest? sulcus TALUS – ARTICULATIONS  4 bones  Tibia  superiorly  Fibula  Superiorly  Calcaneus  Inferiorly  Navicular  Anteriorly  Flattened, oval bone  Located on:  Medial side of foot  Between talus and 3 cuneiforms  5 bones  Talus  Posteriorly  Cuboid  Laterally  3 Cuneiforms  Anteriorly  Located on:  Lateral aspect of foot  Distal to calcaneus  Proximal to 4th & 5th metatarsals  5 bones  Calcaneus  Proximally  Lateral Cuneiform  Medially  Navicular  Medially  4th & 5th metatarsals  Distally  1st cuneiform (medial)  Largest  Articulates with 1st metatarsal  2nd cuneiform (intermediate)  Smallest cuneiform  Articulates with 2nd metatarsal  3rd cuneiform (Lateral)  Articulates with the 3rd metatarsal and cuboid  ALL cuneiforms articulate with the navicular  Tibial & Fibular sesamoid bones  Extra bones embedded in certain tendons  Arches provide:  Strong, shock-absorbing support for the weight of the body  Longitudinal Arch  Medial  Lateral  Transverse Arch  Located along the plantar surface of the distal tarsals and the tarsometatarsal joints  Primarily made of the cuneiforms & cuboid  IP joint DIP joint PIP joint JOINTS MTP joint TMT joint Intertarsal joints WHERE ARE THE JOINTS LOCATED?  Dorsiflexion Plantar flexion MOTIONS OF THE FOOT & ANKLE Inversion (varus) Eversion (valgus)  Distance 40 SID Shielding Radiation – sensitive organs RADIOGRAPHIC Collimation POSITIONING Collimate to all four sides without cutting off essential anatomy CONSIDERATIONS Positioning Place long axis of the part parallel to long axis of IR Grids Greater than 10 cm  Pediatric Allow parents to help Most of all pediatric lower extremity exams will be done the same as adults SPECIAL PATIENT Geriatric CONSIDERATIONS Handle carefully Check for signs of hip fracture (foot in extreme external rotation) Cast conversions What are they?  Fractures  Breaks in the structure of the bone caused by force  Gout  Form of arthritis that may be hereditary in which uric acid appears in excessive quantities in the blood and may be deposited in the joints and other tissues  Common initial attacks occur in the 1st MTP joint of the foot  Joint effusions  Accumulated fluid in the join cavity Hmm… What is the term for fluid in the lungs?  AP ROUTINE VIEWS – TOES Oblique Lateral  Clinical Indications: Fractures & dislocations, Gout (especially in 1st digit)  40 SID  Knee flexed with plantar surface of foot resting on IR  Angle CR 10-15˚ toward calcaneus  CR – MTP joint in question  Collimation:  Include one digit on each side of affected digit  Minimum of distal half of metatarsal included  Clinical Indications: Same as AP  40 SID  Knee flexed with plantar surface of foot resting on IR  Rotation:  Rotate foot 45˚ medial for 1-3 rd digits  Rotate foot 30˚ laterally for 4-5 th digits  CR perpendicular to IR, directed at MTP joint in question Why do we rotate less laterally for 4th&5th digit?  Lateromedial Projection (1st – 3rd digits)  Rotate affected leg and foot medially  Mediolateral Projection (4th & 5th digits)  Rotate affected leg and foot laterally  Use tape, gauze, or tongue blade to flex and separate unaffected toes to prevent superimposition SPECIAL VIEWS –  Sesamoids (tangential) TOES  Patient laying: Prone  Dorsiflex the foot so that the plantar surface of the foot forms a 15-20˚ angle from vertical  Great toe will be dorsiflexed and rest on IR  CR – perpendicular to IR  Directed at 1st MTP joint What is a tangential projection?  ****If your patient can not tolerate laying prone Why do we want to prevent doing it this way if possible?  AP ROUTINE VIEWS – FOOT Oblique Lateral  Plantar surface rest on IR  Angle CR 10˚ posteriorly (toward heel)  CR should be perpendicular to metatarsals  CR – directed to base of 3 rd metatarsal Note: High arch 15˚, Low arch 5˚ Foreign body = 0˚ CR angle   Plantar surface on IR  Medially rotate foot 30-40˚  Dorsum aspect of foot should be parallel to IR  CR perpendicular to IR  Directed at base of 3 rd metatarsal Note: 30˚ lateral oblique for space between 1st & 2nd metatarsals and between 1st and 2nd cuneiforms. Navicular as well  Dorsiflex foot to help place foot & ankle in true lateral  Plantar surface perpendicular to IR  CR- medial cuneiform (level of base of 3 rd metatarsal)  Collimation: include about 1in above ankle joint SPECIAL VIEWS - AP and Lateral (Weight- FOOT bearing)  Patient stands, with full weight evenly distributed  Feet should be direct straight ahead and parallel to each other  Angle CR 15˚ posteriorly  CR – midpoint between feet at level of base of metatarsals  Have patient stand with weight placed on affected foot  Can they stand on the floor?  NO, why?  Have something for the patient to hold on to  Direct CR horizontally  Level of base of 3rd metatarsal Fig. 6.13 Bontrager Fig. 6.14 Bontrager QUIZ ME:  How many bones are located in each foot?  How many tarsal bones do we have?  What are the names of each of the tarsal bones?  Can you find them on the x-rays (AP, Oblique, and Lateral)? QUIZ ME:  Which of the tarsal bones is the largest?  What is the other name for Calcaneus?  What is the common site for bone spurs in the heel?  What attaches at this location? QUIZ ME:  What are the two bumps on the calcaneus called that we can see on the upper portion of the axial view? (answers on slide 8)  Which one is medial?  Which is lateral?  What two bones does the calcaneus articulate with?  What is the other name for talus? QUIZ ME:  What joint is formed between the talus and calcaneus?  What is located between the depression of the talus and calcaneal sulcus for ligaments to pass through?  What bones does the talus articulate with? QUIZ ME:  Which of the tarsal bones is flat and oval, located on the medial side of the foot?  What bones does the navicular articulate with?  Where is the cuboid located?  Which bones does the cuboid articulate with? QUIZ ME:  What are the names of the 3 cuneiforms?  What does each one articulate with?  What bone do they all articulate with?  What are the names of the two small bones located on the 1st metatarsal? QUIZ ME:  Can you label all of the joints on slide 19 on each x- ray?  Define dorsiflexion:  Define plantar flexion:  Define Inversion (varus):  Define Eversion (valgus): QUIZ ME:  What are your cast conversions?  Small to medium plaster?  Large plaster?  Fiberglass?  Define Gout:  Define Joint effusion: QUIZ ME:  How is the CR angled for an AP view of the toes?  Where is the CR located for AP toes?  How do you rotate the foot for the 1-3rd toes for the oblique view of the toes?  How do you rotate the foot for the 4-5th toes for the oblique view of the toes? QUIZ ME:  Where do you Center your CR for the oblique projection of the toes?  How do you perform the lateral view of the toes?  Lateromedial projection vs mediolateral projection?  CR location?  How much is the foot dorsiflexed from vertical for the sesamoid projection of the toes?  Where is your CR directed? QUIZ ME:  If your patient can't lay prone for the sesamoid projection, what can you do?  Why is this not the ideal projection?  How much do you angle the CR for the AP foot?  Average arch?  High arch?  Low arch?  Foreign body?  Where do you center your CR? QUIZ ME:  How much do you rotate the foot for a medial oblique view?  Lateral oblique view?  Where is your CR located for an oblique view of the foot?  Where do you center you CR for a lateral view of the foot? QUIZ ME:  How do you perform an AP weight bearing view of the foot?  Angle of CR?  CR location?  How do you perform a lateral weight bearing view of the foot?  CR location?