This document provides a guide on obtaining neutral and relaxed stance radiographs of the talotarsal joint to diagnose talotarsal dislocation. It emphasizes the importance of taking comparison views to assess the malleability of the deformity and to rule out secondary issues like tarsal coalition. Clear foot positioning and correct x-ray techniques are crucial for obtaining accurate images to aid in treatment recommendations.

1. Guide to:
Neutral and Relaxed Stance Position
Radiographs of the TaloTarsal Joint

2. The best way to diagnose
TaloTarsal Dislocation
is via radiographic examination.

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. 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. Can you pick which view is
relaxed stance or neutral position?

6. Relaxed Stance Position Neutral Stance Position

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. Also, this will help to rule-out the
possibility of a tarsal coalition.

9. Foot Positioning
Relaxed Stance
Neutral Stance

10. Relaxed Stance
That’s the easy position –
patient just stands how they
normally stand.

11. Neutral Position
This is where the TaloTarsal
Joint should naturally be
positioned during stance:
neither
supinated nor pronated.

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. 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. 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. 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. Technique:
Take AP and Lateral Views
Can also take posterior calcaneal
view and AP of the ankle – optional.

17. Lateral X-ray Imaging
Relaxed Stance Position
• Tube is angle 90 degrees.

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. Dare to Compare
Relaxed Stance Position Neutral Stance Position

20. Please make sure your x-ray technician
understands the difference
Relaxed Stance Position Neutral Stance Position

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. AP/DP X-ray Imaging
Relaxed Stance Position
At first glance you may not
identify that this patient has a
partial talotarsal dislocation.

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. 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. See the difference?
Relaxed
Stance
Position
Neutral
Stance
Position

26. Good Luck!
There is another module for the interpretation of these views.
www.HyProCureDoctors.com