Film Critique

1st year 5th class

ToesStandard views

*AP

*Oblique (medioblique)

*Lateral (mediolateral/lateromedial)

Structures shown AP projection of the phalanges of the foot

(*1st toe only has 2 phalanges the 2nd-5th have 3 phalanges) ***We need from distal phalanx to the distal end metatarsal.

AP Right 1st Toe

Sesamoids

Check the film for: No rotation of phalanges Interphalangeal and

metatarsophalangeal joint spaces open (no bent toes)

Toes should be separated from each other so there is no soft tissue overlap

Soft tissue and bony trabeculation (this is to check for a good technique)

AP

Rotation of toe

Soft tissue overlap

AP left 1st toe

Oblique Toes

Oblique left 1st toe

Structures shown **** We do a medioblique:

An oblique projection of the phalanges

The Interphalangeal joints and 2nd -5th metatarsophalangeal joints open

***Distal phalanx to the distal end of the metatarsal

Toes should be separated from each other

Both soft tissue and bony trabeculation should be seen (techn)

Oblique left 2nd toe

Cadaver bone

LT

Lateral left 1st toe

Might need tape, straw or tongue depressor to separate toes

Lateral toes

Do lateromedial (1st-3rd) and mediolateral (3rd-5th) to get the toe closest to the film

lateromedial Mediolateral

Lateral left 2nd toe Lateral left 3rd toe

Structures shown: Lateral toe A lateral projection of the phalanges: Phalanges in profile

(toenail should appear lateral)

The interphalangeal joints spaces open. The MTP joints will be overlapped but may be seen in some patients.

***The distal phalanx to the distal ends of the metatarsals

Phalanx, without superimposition of adjacent toes. When superimposition cannot be avoided, the proximal phalanx must be demonstrated.

Toes should be separated from each other

Soft tissue and bony trabeculation (techn)

Lateral left 1st toe

Lateral left 2nd toe

Tongue depressor

Lateral Left 2nd toe

Foot

Standard views

*AP

* AP Oblique (medioblique)

*Lateral (mediolateral)

Base of the 5th

Common area for a foot fracture base of 5th Jones fracture

AP Right Foot

Intermediate

AP Right foot

**In this view you Will not see theCalcaneus!!

Structures shown:

Dorsoplanter (AP) projection of the tarsals anterior to the talus, the metatarsals,and the phalanges

You will not see the whole calcaneus on this view. Why?

Some people angle 10 degrees toward the heel on this view

***You want all of the phalanges, metatarsals and tarsals distal to the talus on your image

Check film for:

Motion

Rotation: there will be overlap of second- fifth metatarsal bases

Open joint space between medial and intermediate cuneiform

No overlap of toes

Density- are the toes burned out

Oblique Right foot

Oblique Right Foot

medioblique

Structures shown: AP medioblique projection of the

phalanges and metatarsals Interspaces open between the cuboid

and calcaneus, the cuboid and the 4th and 5th metatarsals, the cuboid and the lateral cuneiform and the talus and the navicular

Cuboid is in profile Sinus tarsi, calcaneus, navicular,&

base of the fifth are seen

Oblique Left Foot

Calcaneus?

Check for: Enough rotation when the 3rd – 5th

metatarsals bases are free from superimposition

The lateral tarsals with less superimposition than in the AP

Joint spaces open Base of the fifth metarsal is seen Density: are the toes seen and are

the tarsal seen Tip of toes to calcaneus on the image

Lateral Right Foot

Lateral Right Foot

mediolateral

R

Structures shown:

Mediolateral projection of the entire foot. ***You need distal ends of the tib/fib, ankle joint, calcaneus to the distal phalanges.

Bad lateral foot

Check for:

Tip of toes to calcaneus and distal tib/fib on the image

Metatarsals nearly superimposed

Density to see toes, metatarsals and tarsals

Good Positioning

Poor : knee elevated

Poor : heel not flat

Poor : foot not flat

NO!

CALCANEUS

Standard views

*AP axial (plantodorsal)

*Lateral (mediolateral)

Sustentaculumtali

tuberosity

Trochlear process

Structures shown:

An axial projection of the calcaneus ***from the tuberosity to the sustentaculum tali and trochlear process

AP Axial Right Calcaneus

Check for:

Calcaneus should be visualized to include the talocalcaneal joint

No rotation of calcaneus (check the first or fifth metatarsals)

Density to see joint without burn out of tuberosity (two films if not using DR or CR)

Rotation / foot flexion

GoodRotation : can see 4th & 5th metatarsals

Too much flexionCan’t see joint space

Structures shown:

Lateral projection of the ankle joint and the calcaneus and adjacent tarsals.

Lateral Left calcaneus

Check for:

No rotation of the calcaneus Density can you see soft tissue and

bone Sinus tarsi seen Ankle joint and adjacent tarsals

should be on the film

Ankle

Standard views

*AP

*OBL (mortise)

*Lateral (mediolateral)

AP Right Ankle

Structures shown

AP projection of the ankle joint, ***distal ends of tib/fib and the proximal portion of the talus

Dorsal flexAP Left ankle

Check for:

Talotibial joint space should be seen

Ankle joint should be centered

Moderate over lapping at the tibiofibular articulation is normal

***Area from the distal tibia and fibula to the talus should be included

Oblique Left Ankle

Structures shown:

Distal ends of the tib/fib with the entire ankle mortise joint demonstrated in profile.(all three sides of the mortise joint should be open.)

AP OBLIQUE ANKLE The entire ankle mortise joint should be

demonstrated in profile. We oblique 15-20 degrees to open all three joints.

AP Toomuch

Oblique Right Ankleis it open?

Don’t just dorsiflex the foot, roll the leg

Check for:

Entire ankle mortise joint No overlap of the anterior tubercle of

the tibia and the superolateral portion of the talus with the fibula

Talofibular joint space in profile Talus demonstrated with proper

density

Lateral Right Ankle

Lateral ankle (mediolateral)

A true lateral image of the lower third of the tib/fib, the ankle joint and the tarsals including the base of the 5th metatarsal

Lateral Right Ankle

Poor positioningDorsiflex the foot

Check for: Ankle joint should be centered Talotibial joint should be well

visualized Fibula should be over the posterior

half of the tibia Density of ankle should be sufficient

to see the outline of the distal portion of the fibula

Fifth metatarsal should be seen to check for a Jones fracture