X-ray positioning of the lower leg
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
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| AP Toes | CR angle 10-15 degrees towards calcaneus, 15 degree wedge could be used and the CR perpendicular.
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| AP Oblique (Medial or Lateral) Toes | Rotate leg and foot 30-45 degrees medially (1-3 MT), laterally (4-5 MT), 45 degree wedge for support and CR perpendicular
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| Lateral (Mediolateral or Lateromedial) Toes | Rotate affected leg and foot medially (1-3 MT) laterally (4-5 MT) CR perpendicular, Concave on anterior distal phalanx and posterior proximal phalanx
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| Tangential Toes Sesamoids | Dorsiflex foot so plantar surface forms 15-20 degree angle from vertical, CR perpendicular, sesmoids free superimposition 1-3 distal metatarsals in profile. Alternate will result in OID, magnification, and loss of definition
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| AP Foot "Foreign bodies" Dorsoplantar | CR angle 10 degrees posteriorly towards heel, CR perpendicular to metatarsals, 2-5 MT bases overlap, Intertarsal joint space open
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| AP Oblique (Medial) Foot "Foreign bodies" | Rotate foot medially for plantar surface 30-40 degrees to plane of IR (3-5 MT), Rotate 30 degrees laterally for lateral oblique (1-2 MT), 45 degree wedge for support, Cr Perpendicular, 1-2 MT bases overlap, 5th MT tuberosity in profile, sinus tarsi open
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| Lateral (Mediolateral/ lateromedial) Foot "Foreign bodies" (lateromedial is unconfortable but easier for true lateral) | Flex knee 45 degrees, dorsiflex foot, CR perpendicular to medial cuneiform, support so plantar surface is perpendicular to IR, distal MT are superimposed, 5th MT tuberosity in profile, tibia and fibula are superimposed, tibiotalar joint open
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| AP Weight Bearing Foot "longitudinal arches, Lisfranc joint injury" | Patient erect, weight evenly distributed, CR 15 degrees posteriorly to midpoint between feet at level of base of metatarsals, tarsometatarsal joint open, 1-2 cuneiform joint open
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| Lateral Weight Bearing Foot "longitudinal arches, Lisfranc joint injury" | Patient erect, weight on affected foot (1 image at a time), CR horizontal at base of 3rd MT, Fibula superimposed over tibia, distal metatarsals superimposed, soft tissue from dorsum to plantar surfaces, 1" distal tibia and fibula
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| Plantodorsal Axial Calcaneus "Fractures, medial lateral displacement in calcaneus" | Fully extended leg, dorsiflex foot until plantar surface is near perpendicular to IR, Angle 40 degrees cephalad from long axis of foot,calcaneus,sustentaculum tali profile medially, elongated calcaneus, open talocalcaneal, calcaneal tuberosity
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| Lateral (mediolateral) Calcaneus | True lateral (lateral malleolus 1cm posterior to medial) Dorsiflex foot, CR perpendicular 1" inferior to medial malleolus, calcaneus profile, talus tib fib superiorly, lat. mall. sup.imp. over pos 1/2 of tibia and talus, tarsal sinus, calcaneocuboid open
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| AP Ankle "5th prox. MT, ankle joint" | Fully extended leg, foot and ankle in true AP, CR perpendicular medial mortise open, lateral mortise closed, some superimposition of distal fibula by distal tibia and talus, lateral malleolus is 15 degrees more posterior
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| AP Mortise 15-20 degree medial Ankle "5th prox. MT, common during open reduction surgery" | Fully extended leg, internally rotate 15-20 degree for parallel intermalleolar line, CR perpendicular, tibial plafond, entire mortise joint open, lateral and medial malleolus in profile, min. superimposition exists at distal tibiofibular joint
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| AP Oblique (medial) Ankle "distal tibiofibular joint, distal fibula, lateral malleolus, and base of 5th MT" | Fully extended leg, dorsiflex so plantar surface is 80-85 degrees from IR, rotate leg and foot 45 degrees medially, CR Perpendicular, distal tibiofibular joint open, lateral malleolus and talus little/no superimposition, medial mall. slight Sup.Imp. talus
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