XRAY ANKLE POSITIONING

1. ANATOMY & POSITIONING OF
ANKLE JOINT CALCANEUM AND
SUBTALAR JOINT
Dr.Pradeep Patil
D.Y.PATIL MEDICAL COLLEGE HOSPITAL AND
RESEARCH INSTITUTE
KOLHAPUR

16. AP view of ankle-Mortise(basic) view
Position :-
• Pt is either supine /seated on the table with legs extended.
• The ankle is supported in dorsiflexion by a 90 degree pad placed against plantar aspect.
• The limb is rotated medially 20 deg until the medial and lateral malleoli are equidistant from the receptor.
•If patient is unable to dorsiflex the foot sufficiently then raising the heel by 15degree wedge or using 5-10degree of
cranial tube angulation.
•The mid-tibia may be immobilized using sandbag.
Direction and location of the X-ray beam
•The collimated vertical beam Centred midway between the malleoli with the ray at 90 deg to imaginary line joining the
malleoli.

17. Common faults and solutions
• Insufficient dorsiflexion results in calcaneum being superimposed on lateral
malleolus.
• Insufficient medial rotation causes overshadowing of tibio-fibular joint space
between fibula and talus nor seen clearly.

21. Essential image characteristics
• The lower third of the tibia and fibula should be included.
• A clear joint space between the tibia, fibula and talus should be demonstrated.
(commonly called the Mortise view).
Common faults and solution
• Insufficient dorsiflexion results in the calcaneum being superimposed
on the lateral malleolus.
• Insufficient medial rotation causes overshadowing of the tibiofibular
joint with the result that the joint space between the
fibula and talus is not demonstrated clearly.
Indications:-
•Osteochondral fractures
•Malleolar fractures

26. Calcaneum-Lateral view
Position
• From the supine position, the patient rotates on to the affected side.
• Leg rotated until the medial and lateral malleoli are superimposed vertically.
• A 15-degree pad is placed under the anterior aspect of the knee and the lateral border of the forefoot for support.
• The receptor placed with lower edge just below plantar aspect of heel
Direction and location of the X-ray beam
• Beam is Centred 2.5 cm distal to the medial malleolus, with the central ray perpendicular to the receptor.

27. Essential image characteristics
• The adjacent tarsal bones should be included in the lat projection together
with ankle joint.
• This projection is used to demonstrate calcaneal spurs.

28. Calcaneum-axial view
Position
• The patient sits on xray table with both limbs extended.
• The affected leg is rotated medially until both malleoli are equidistant from receptor.
• The ankle is dorsiflexed.
• The position is maintained by using a bandage strapped around the forefoot and held in position by the patient.
• The receptor is positioned with its lower edge just distal to plantar aspect of the heel.
Direction and Location of the X-ray beam
• Collimated beam is Centred to the plantar aspect of the heel at the level of the tubercle of the fifth metatarsal.
• The Xray tube is directed cranially at an angle of 40 degrees to the plantar aspect of the heel.

29. Essential image characteristics
• The subtalar joint should be visible on the axial projection.
• The inferior aspect of he calcaneum and soft tissue borders also demonstrated.
Indications
• Fractures of calcaneum

30. Subtalar joints
• There are 3 articular surfaces of subtalar joints that is Anterior,middle and
posterior.

31. Subtalar Joints-Dorsi-plantar oblique(DPO) View

32. Subtalar Joints- Lateral oblique

33. Subtalar joints- oblique medial
Position
• The patient lies supine on the X-ray table, with the affected limb extended.
• The ankle joint is dorsiflexed and the malleoli are equidistant from the film.
• The leg is internally rotated through 45 degrees.
• A non-opaque square pad and sandbag may be placed against the plantar aspect of the foot to keep the ankle
joint in dorsiflexion.
Direction and centering of the X-ray beam
• Centre 2.5 cm distal to the lateral malleolus with the following cranial angulations:
10 20 30 40
45

34. 40 degree angulation
10 degree angulation 20 degree angulation
Direction and centering of the X-ray beam
• Collimated Beam Centred 2.5 cm distal to the lateral malleolus with the following cranial angulations:
• Collimate to include the ankle mortise,calcaneum and proximal 1/3of the metatarsals.

35. Subtalar joints-Oblique lateral

36. THANK YOU