Neutral and Relaxed Stance X-ray Positioning for TaloTarsal Joint Dislocation

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This module explains the radiographic positioning of the hindfoot to assist in the diagnosis of talotarsal dislocation.

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Neutral and Relaxed Stance X-ray Positioning for TaloTarsal Joint Dislocation

  1. 1. Guide to: Neutral and Relaxed Stance Position Radiographs of the TaloTarsal Joint
  2. 2. The best way to diagnose TaloTarsal Dislocation is via radiographic examination.
  3. 3. • How flexible/reducible is this partial talotarsal dislocation deformity? • You can’t tell with this static relaxed position radiograph. • That’s why there is a need to take comparison views.
  4. 4. Radiographic Comparison • Provides objective data (can draw angles to compare normal versus abnormal accepted angular measurements) • Excellent educational tool to show the patient their hindfoot deformity • Documents the flexibility of the deformity • Rules out secondary pathologies
  5. 5. Can you pick which view is relaxed stance or neutral position?
  6. 6. Relaxed Stance Position Neutral Stance Position
  7. 7. If you are going to recommend an EOTTS-HyProCure procedure it is very important to show radiographic evidence that the dislocation deformity is flexible.
  8. 8. Also, this will help to rule-out the possibility of a tarsal coalition.
  9. 9. Foot Positioning Relaxed Stance Neutral Stance
  10. 10. Relaxed Stance That’s the easy position – patient just stands how they normally stand.
  11. 11. Neutral Position This is where the TaloTarsal Joint should naturally be positioned during stance: neither supinated nor pronated.
  12. 12. Normal TaloTarsal Joint Alignment • The talus should be balanced on the calcaneus and navicular. • Sinus tarsi is “open” • TTJ articular facets are in Constant Congruent Contact
  13. 13. Foot Positioning Neutral Stance Position The bisection of the leg (black line) should line up with the bisection of the 2nd metatarsal (green line).
  14. 14. Foot Positioning Supinated-Overcorrected Position The juncture of the 2 lines bends outward/laterally. This indicates a supinated hindfoot. It is better to place the foot in a more supinated verse a more pronated position. The goal is to show that the talus can resupinate on the calcaneus.
  15. 15. Sign of TaloTarsal Dislocation There is an inner/medial bend of the bisection of the leg and 2nd metatarsal. “Pronated” position of the hindfoot. Only a very “slight” amount of pronation is acceptable.
  16. 16. Technique: Take AP and Lateral Views Can also take posterior calcaneal view and AP of the ankle – optional.
  17. 17. Lateral X-ray Imaging Relaxed Stance Position • Tube is angle 90 degrees.
  18. 18. Lateral X-ray Imaging Neutral Stance Position • The patient’s hindfoot is repositioned so that it is neither supinated nor pronated. • The talus is repositioned the talus back on top of the calcaneus.
  19. 19. Dare to Compare Relaxed Stance Position Neutral Stance Position
  20. 20. Please make sure your x-ray technician understands the difference Relaxed Stance Position Neutral Stance Position
  21. 21. AP/DP X-ray Imaging Relaxed Stance Position • Tube head is 15 degrees aimed at the mid-foot. • Patient is standing on the x-ray plate.
  22. 22. AP/DP X-ray Imaging Relaxed Stance Position At first glance you may not identify that this patient has a partial talotarsal dislocation.
  23. 23. AP/DP X-ray Imaging Relaxed Stance Position At first glance you may not identify that this patient has a partial talotarsal dislocation. However, on closer examination: there is a medial bend to the bisection lines.
  24. 24. AP/DP X-ray Imaging Neutral Stance Position The x-ray will show a normal talotarsal joint alignment. Make sure there is no “inner” bend to the junction of the bisection of the leg and 2nd metatarsal bone.
  25. 25. See the difference? Relaxed Stance Position Neutral Stance Position
  26. 26. Good Luck! There is another module for the interpretation of these views. www.HyProCureDoctors.com

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