1. Film Critique
1st year 5th class

2. Toes Standard views *AP *Oblique (medioblique)
*Lateral (mediolateral/lateromedial)

3. Structures shown
AP projection of the phalanges of the foot (*1st toe only has 2 phalanges the 2nd-5th have 3 phalanges) ***We need from distal phalanx to the distal end metatarsal.

4. AP Right 1st Toe
Sesamoids

5. Check the film for: No rotation of phalanges
Interphalangeal and metatarsophalangeal joint spaces open (no bent toes)
Toes should be separated from each other so there is no soft tissue overlap
Soft tissue and bony trabeculation (this is to check for a good technique)

6. AP left 1st toe
Rotation of toe
Soft tissue overlap AP

7. Oblique Toes

8. Oblique left 1st toe

9. Structures shown An oblique projection of the phalanges
**** We do a medioblique:
An oblique projection of the phalanges
The Interphalangeal joints and 2nd -5th metatarsophalangeal joints open
***Distal phalanx to the distal end of the metatarsal
Toes should be separated from each other
Both soft tissue and bony trabeculation should be seen (techn)

10. Oblique left 2nd toe LT
Cadaver bone

11. Lateral left 1st toe
Might need tape, straw or tongue depressor to separate toes

12. Lateral toes Lateral left 3rd toe Lateral left 2nd toe lateromedial
Mediolateral
Do lateromedial (1st-3rd) and mediolateral (3rd-5th) to get the toe closest to the film

13. Structures shown: Lateral toe
A lateral projection of the phalanges: Phalanges in profile (toenail should appear lateral)
The interphalangeal joints spaces open. The MTP joints will be overlapped but may be seen in some patients.
***The distal phalanx to the distal ends of the
metatarsals
Phalanx, without superimposition of adjacent toes. When superimposition cannot be avoided, the proximal phalanx must be demonstrated.
Toes should be separated from each other
Soft tissue and bony trabeculation (techn)

14. Lateral left 2nd toe
Lateral left 1st toe

15. Tongue depressor
Lateral Left 2nd toe

16. Foot Standard views *AP * AP Oblique (medioblique)
*Lateral (mediolateral)

17. Common area for a foot fracture base of 5th Jones fracture
AP Right Foot
Intermediate
Base of the 5th
Common area for a foot fracture base of 5th Jones fracture

18. AP Right foot
**In this view you
Will not see the
Calcaneus!!

19. Structures shown:
Dorsoplanter (AP) projection of the tarsals anterior to the talus, the metatarsals,and the phalanges
You will not see the whole calcaneus on this view. Why?
Some people angle 10 degrees toward the heel on this view
***You want all of the phalanges, metatarsals and tarsals distal to the talus on your image

20. Check film for:
Motion
Rotation: there will be overlap of second- fifth metatarsal bases
Open joint space between medial and intermediate cuneiform
No overlap of toes
Density- are the toes burned out

21. Oblique Right foot

22. Oblique Right Foot
medioblique

23. Structures shown:
AP medioblique projection of the phalanges and metatarsals
Interspaces open between the cuboid and calcaneus, the cuboid and the 4th and 5th metatarsals, the cuboid and the lateral cuneiform and the talus and the navicular
Cuboid is in profile
Sinus tarsi, calcaneus, navicular,& base of the fifth are seen

24. Oblique Left Foot
Calcaneus?

25. Check for:
Enough rotation when the 3rd – 5th metatarsals bases are free from superimposition
The lateral tarsals with less superimposition than in the AP
Joint spaces open
Base of the fifth metarsal is seen
Density: are the toes seen and are the tarsal seen
Tip of toes to calcaneus on the image

26. Lateral Right Foot

27. Lateral Right Foot R
mediolateral

28. Structures shown:
Mediolateral projection of the entire foot. ***You need distal ends of the tib/fib, ankle joint, calcaneus to the distal phalanges.

29. Bad lateral foot

30. Check for: Tip of toes to calcaneus and distal tib/fib on the image
Metatarsals nearly superimposed
Density to see toes, metatarsals and tarsals

31. Good Positioning
Poor : heel not flat
Poor : knee elevated
Poor : foot not flat

32. NO!

33. CALCANEUS Standard views *AP axial (plantodorsal)
*Lateral (mediolateral)

34. Sustentaculum
tali
Trochlear
process
tuberosity

35. Structures shown:
An axial projection of the calcaneus ***from the tuberosity to the sustentaculum tali and trochlear process

36. AP Axial Right Calcaneus

37. Check for:
Calcaneus should be visualized to include the talocalcaneal joint
No rotation of calcaneus (check the first or fifth metatarsals)
Density to see joint without burn out of tuberosity (two films if not using DR or CR)

38. Rotation / foot flexion
Rotation : can see
4th & 5th metatarsals
Too much flexion
Can’t see joint space
Good

40. Structures shown:
Lateral projection of the ankle joint and the calcaneus and adjacent tarsals.

41. Lateral Left calcaneus

42. Check for: No rotation of the calcaneus
Density can you see soft tissue and bone
Sinus tarsi seen
Ankle joint and adjacent tarsals should be on the film

43. Ankle
Standard views
*AP
*OBL (mortise)
*Lateral (mediolateral)

44. AP Right Ankle

45. Structures shown
AP projection of the ankle joint, ***distal ends of tib/fib and the proximal portion of the talus

46. Dorsal flex AP Left ankle

47. Check for: Talotibial joint space should be seen
Ankle joint should be centered
Moderate over lapping at the tibiofibular articulation is normal
***Area from the distal tibia and fibula to the talus should be included

48. Oblique Left Ankle

49. Structures shown:
Distal ends of the tib/fib with the entire ankle mortise joint demonstrated in profile.(all three sides of the mortise joint should be open.)

50. AP OBLIQUE ANKLE
The entire ankle mortise joint should be demonstrated in profile. We oblique degrees to open all three joints.
Too
much AP

51. Oblique Right Ankle is it open?

52. Don’t just dorsiflex the foot, roll the leg

53. Check for: Entire ankle mortise joint
No overlap of the anterior tubercle of the tibia and the superolateral portion of the talus with the fibula
Talofibular joint space in profile
Talus demonstrated with proper density

54. Lateral Right
Ankle

55. Lateral ankle (mediolateral)
A true lateral image of the lower third of the tib/fib, the ankle joint and the tarsals including the base of the 5th metatarsal

56. Poor positioning
Dorsiflex the foot
Lateral Right Ankle

57. Check for: Ankle joint should be centered
Talotibial joint should be well visualized
Fibula should be over the posterior half of the tibia
Density of ankle should be sufficient
to see the outline of the distal portion of the fibula
Fifth metatarsal should be seen to check for a Jones fracture