X ray ankle and foot radiographs are takent in day by day in radiological work up study done at Smbt medical college nashik. different radiographs are described with Hows its taken? and at what Kv given. refrence taken from YOCHUM Rowe book of radiology.

1. ANKLE, FOOT
RADIOGRAPHS AND
COMMON
PATHOLOGIES
BY :- DR AVINASH DAHATRE
RADIOLOGY DEPARTMENT

2. ANATOMY OF ANKLE

3. ANKLE JOINT
▪ It is Synovial type of hinge joint.
▪ Formed by articulation of Tallus withTibia
and Fibula.
▪ Function:- plantar flexion and dorsiflexion.
▪ Below the true ankle joint second part of
ankle is Subtalar joint.
▪ Subtalar joint is formed by tallus superiorly
and calcaneus below.

4. NORMAL RADIOGRAPHIC
VIEWS

5. ANKLE APVIEW
Demonstrate :-Tibia, fibula, talus
and ankle joint.
KVP:- 55 (50 – 60)
Film size :-10x12 inch
Grid:- No.
Patient position :- Supine.
Part position:- Ankle is dorsiflexed
so that surface of foot is
perpendicular to the film.
Centring :- Half way between
medial and lateral malleolus.
Collimation :- 6x10inch field

6. •Articular surface of distal tibia and talar
dome should be parallel.
•Inferior articular surface of tibia called as
tibial plafond (ceiling).
•Growth plate (physeal scar) oftenly seen
parallel to plafond.
•Lateral malleolus is bulbous toward distal
end and has groove called peroneal groove
through which peroneal tendon pass.
•Distance between medial malleolus and
medial talar dome and lateral malleolus
and lateral talar dome should be same
distance.(5mm)

7. COMMON PITFALLS
▪ Lack Of Dorsiflexion:- tibiotalar joint space
and lateral malleolus will not be visualized b
cause of over lap.
▪ In case of plaster or cast : Increase Kv by 5
to achieve improved penetration.
▪ Demonstration of distal tibia and fibula
should be included when symptoms are
proximal to ankle.

8. MORTISE VIEW
Demonstrate :-Tibia, fibula, talus and
ankle joint.
KVP:- 55 (50 – 60)
Film size :-10x12 inch
Grid:- No.
Patient position :- Supine.
Part position:- Ankle is dorsiflexed so that
surface of foot is perpendicular to the film.
Lower leg is internally rotated so that
intermalleolar line forms angle of 35
degree.
Centring :- Half way between medial and
lateral malleolus.
Collimation :- 6x10inch field

9. •The view is called mortise because
entire joint space is seen in one view.
•Demonstration of distal tibio fibular
joint separation of 2mm.
•Measurement of >5 mm indicate
diastasis.
•Lateral and medial malleoli are clearly
shown and overlap of distal tibiofibular
is reduced.
•Most imp view for detecting subtle
fracture of distal fibula, posterior tibia
and talar dome.

10. COMMON PITFALLS
▪ Inadequate dorsiflexion:- calcaneus will
overlap lateral malleolus.
▪ Incorrect medial rotation:- results in
overlaping of medial malleolus on medial
clear space.

11. ANKLE LATERAL
VIEW
DEMONSTRATE:-tibia, fibula,
ankle joint tallus, calcaneus.
KvP:- 55
FILM SIZE:- 8x10 inch
PATIENT POSITION:-lateral
recumbent.
PART POSITION:-Lateral surface
of ankle in contact with the film with
slightly dorsiflexed.
CENTRING:- Given on medial
malleolus
COLLIMATION:-8x10 inch field.

12. •Noted the tibia on tallus.
•calcaneus is upward.
•Downward-sloping metatarsal forms
the longitudinal arch of foot.
•Surface of convex talus reciprocal
with concave surface of tibial plafond.
•Talocalcaneal joint is seen in
midsection where sinus tarsi is found.
•Normal trabecular pattern seen on
calcaneus that pass upward to
subtalar joint.

13. ANATOMY OF FOOT

14. ARCHES OF FOOT
▪ MEDIAL LONGITUDENALARCH:-
Formed by calcaneus, navicular,3 cuneiform
bones and 3 metatarsals.
 LATERAL LONGITUDENALARCH:-
Formed by lateral calcaneus, cuboid and two
metatarsals.
 TRANSVERSEARCH:-
Form by cuneiform, cuboid and metatarsals
bone.

15. X RAY VIEWS

16. FOOT APVIEW
DEMONSTRATE:- Phalanges,
cuneiform bones, metatarsals,
navicular and cuboid.
KvP:- 55 (50-60)
FILM SIZE:-10x12 inch.
PATIENT POSITION:-Supine with knee
flexed, or standing.
PART POSITION:-Knee is flexed so
that the plantar surface should rest on
cassette.
CENTRING:- Base of 3rd metatarsal.
COLLIMATION:- 5x12 inch field.

17. •Each phalynx has expanded ends
which are radiolucent.
•Expanded distal end of distal
phalynx are termed as Ungula tufts.
•Articulations of tarsometatarsal,
cuneiform, and cuboid are not well
seen on this view.
•Tarsometatarsal joint is known as
Lisfranc’s joint.
•The talo navicular and
calcaneocuboid joint articulation is
known as chopart’s joint.

18. COMMON PITFALLS
▪ Uneven exposure:-Wedge filter to be used to
prevent overexposure.
▪ Toe flexion or extension:- when toes are flexed or
extended joint spaced will not be depicted.

19. FOOT LATERALVIEW
DEMONSTRATE:-distal tibia,
fibula, tarsals, ankle joint,
metatarsal and phalanges.
KvP:-55 (50-60)
FILM SIZE:- 8x10 inch.
PATIENT POSITION:- lateral
recumbent or standing.
PART POSITION:- affected leg
placed in true lateral projection
with fifth metatarsal in contact
with the film.
CENTRING:- At navicular.
COLLIMATION:- to the film.

21. ▪ Note the position of tibia on tallus.
▪ Calcaneus is angle cephalad relative to plane of
forefoot and midfoot.
▪ Talus, calcaneus, navicular, cuboid are clearly visible
and base of fifth metatarsal is well demonstrated.
▪ First metatarsal is recognised by shortest, broadest,
with largest head.
▪ Subtalar joint is visible in midsection with sinus tarsi.
▪ Calcaneocuboid joint is visible inferiorly.

22. COMMON PITFALLS
▪ FOOT over-rotation:- care must be taken to
achieve lateral of foot.

23. FOOT OBLIQUEVIEW
DEMONSTRATE:- Phalanges, metatarsal,
cuboid, third cuneiform, navicular and
distal calcaneus.
KvP:-55
FILM SIZE:- 10x12 inch.
PATIENT POSITION:-supine with knee
flexed or standing.
PART POSITION:-begins with knee flexed
with foot rest flat on film and leg is rotated
medially so that plantar surface of foot
forms angle of 35 degree.
CENTRING:- to the base of third
metatarsal.
COLLIMATION:- 5x12 inch field.

24. •It is the important view in assesment of
lateral foot pain to show cuboid and fifth
metatarsal.
•Joint relationship especially of toes are
well appreciated in this plane to show
latent dislocations.
•Clear depiction of cuboid, navicle,
3cuneiform bones and base of adjacent
metatarsals.
•It is the excellent view for detecting bony
bridging across joints.

25. COMMON PITFALLS
▪ Uneven exposure:- wedge filter can be used.
▪ Tube tilt improves tarsometatarsal articulations.

26. CALCANEUS AXIAL VIEW
DEMONSTRATE:- Body and posterior calcaneus
Tube tilt:- 35-40degree
Patient position :- supine with legs extended.
Part position:- Foot is dorsiflexed such that plantar
surface is perpendicular to Film.

28. LATERAL VIEW OF CALCANEUS
▪ DEMONSTRATE:- calcaneus,Tallus, subtalar joints
and tendo achilles.
▪ Patient position :- Lateral recumbent.
▪ Part position:-Lateral side of foot is in contact with
the film and plantar surface perpendicular to film.
▪ Centring:- Mid calcaneus

29. LATERALVIEW OF CALCANEUS

30. BOHLER’S ANGLE
Angle between two tangent lines drawn across the
anterior and posterior borders of the calcaneus in the
lateral view. <20 s/o CALCANEAL FRACTURE.

31. COMMON PATHOLOGIES OF
ANKLE AND FOOT

32. GOUT
▪ Gout is a crystal arthropathy due to deposition of
monosodium urate crystals in and around the
joints.
▪ Pathology: Monosodium urate crystals deposition
in periarticular soft tissues.
▪ The primary risk factor is hyperuricemia with levels
of uric acid (≥7 mg/dL) in the blood
▪ Presentation: - Typically in the lower limb and
classically affecting the first metatarsophalangeal
joint
- monoarticular red, inflamed, swollen joint.

33. •Classic marginal erosions
(red arrow)
•Overhanging cortex (blue
arrow)

34. Joint effusion (earliest sign)
Punched-out lytic bone lesions
Preservation of joint space until late
stages of the disease
Overhanging sclerotic margins
Osteonecrosis can be seen.

35. BRODIES ABCESS OF DISTAL
TIBIA
Chronic
intraosseous
abscess resulting
from incomplete
resolution of
osteomyelitis.
Most common
site is distal tibia
metaphysis.

36. SYNOVIAL CYST OR GANGLIA
▪ Most common
around ankle and
foot.
▪ It is the para-
articular fluid
filled sac or pouch
lined by synovial
membrane.

37. ACHILLES TENDINOPATHY
Thickening of achilles
tendon seen on
lateral view of ankle.

38. CALCANEAL APOPHYSITIS or
SEVER DISEASE
It is the painful
inflammation of the
apophysis of
the calcaneus.
Presents in active young
children and
adolescents, especially
those who enjoy
jumping and running
sports.

39. FRACTURES

40. Jones fracture
It is an extra-
articular fracture
at the base of the
fifth metatarsal
bone.

41. Pseudo-jones fracture or
a Dancer fracture
Avulsion
fracture of fifth
metatarsal
occurs due to
forceful
inversion of
foot.

42. MARCH FRACTURE/STRESS OR
FATIGUE FRACTURE
▪ Fracture of 2nd
metatarsal due to
repititive trauma.

43. PILON FRACTURE
▪ A pilon fracture is a type of distal tibial fracture
involving the tibial plafond

44. Comminuted ,displaced Fracture involves the tibial plafond
and the distal tibial articular surface along with fibula.

45. CHOPART’S FRACTURE-
DISLOCATION

46. LISFRANC’S FRACTURE
 Dislocation of the articulation
of the tarsus with the
metatarsal bases.
Displacement of 2nd to
5th metatarsals where the
1st MTP joint remains
congruent.

47. Lovers fracture or Don Juan
fracture or Casanova fracture
lover's fracture" is
derived from the fact
that a suitor may jump
from great heights
while trying to escape
from the lover's spouse.

48. Accessory navicular
 Large accessory ossicle that
can be present adjacent to the
medial side of
the navicular bone.
first appears in adolescence.
more common in female
patients.