ankle and foot standard ankle series ap ankle medial oblique ankle lateral ankle
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Ankle and foot
Standard Ankle SeriesStandard Ankle Series
• AP Ankle
• Medial Oblique Ankle
• Lateral Ankle
AP AnkleAP Ankle• Projection requires 5o of
internal rotation and dorsiflexion
Without internal rotation, overlap of structures
Medial Oblique AnkleMedial Oblique Ankle
• Requires approximately 15-30° of internal rotation
Lateral Lateral Ankle Ankle
• Achilles tendon
• Kager’s Kager’s TriangleTriangle - the fat pad anterior to the Achilles
Accessory Views of the AnkleAccessory Views of the Ankle• InversionInversion and EversionEversion Stress
views
Inversion stress view
• Lateral collateral ligament sprain in a 13 y/o girl.
• Sprain of lateral collateral ligaments in 31 y/o actress.
• Sprain of lateral collateral ligaments in a 20 y/o woman.
Normal Variants of the Normal Variants of the AnkleAnkle
Talar BeakTalar Beak
• an osseous projection of the talar neck
Calcaneal Calcaneal ApophysisApophysis
• a fragmented and fragmented and scleroticsclerotic appearance to the calcaneal apophysis
• given the name Sever’s DiseaseSever’s Disease
Kager’s Triangle
Tarsal Tarsal CoalitionCoalition
• a fibrous or osseous union between two tarsal bones
Os PeroneumOs Peroneum
• located adjacent to the cuboid
Os Tibiale Os Tibiale ExternumExternum
• located just medial to the navicular
Os TrigonumOs Trigonum
• located posterior to the ankle joint
Os SupranavicularOs Supranavicular
• located superior to the navicular
Standard Foot SeriesStandard Foot Series
• AP Foot
• Medial Oblique Foot
• Lateral Foot
AP FootAP Foot
Medial Medial Oblique FootOblique Foot
• 30o of internal rotation
Lateral Foot Lateral Foot ProjectionProjection
Accessory Views of the Accessory Views of the FootFoot
Tangential CalcaneusTangential Calcaneus
• 45o cephalad tube tilt
Anatomic Regions of the FootAnatomic Regions of the Foot
• ForefootForefoot metatarsals and phalanges
• MidfootMidfoot navicular, cuboid, and cuneiforms
• HindfootHindfoot calcaneus and talus
Metatarsal Growth CentersMetatarsal Growth Centers
• epiphyseal growth centers:– distal aspectdistal aspect
of the 2nd to 2nd to 5th 5th metatarsals
– proximal proximal aspectaspect of the 1st 1st metatarsal
5th Metatarsal Styloid 5th Metatarsal Styloid ProcessProcess
Secondary Ossification CenterSecondary Ossification Center
Normal Variants of the FootNormal Variants of the Foot
Phalangeal SynostosisPhalangeal Synostosis
• aka sypmphalangism
Hallux ValgusHallux Valgus• Denotes the valgus position of the
1st toe and the medial plateau-like protrusion of the 1st metatarsal head.
• may be developmental or congenital.
• Associated with sagging of the transverse and longitudinal arches with sideways splaying of the forefoot.
• may have enlargement of the bursa medial to the 1st metatarsal head.
Hallux RigidusHallux Rigidus
• a stiff painful 1st metatarsalphalangeal joint
• may later result in degenerative joint disease
Morton’s SyndromeMorton’s Syndrome
• an abnormally short first metatarsalabnormally short first metatarsal• AKA metatarsus atavicusAKA metatarsus atavicus• the second metatarsal experiences excess stress and
has an increase in transverse diameter of its shaft and in the thickness of its cortical wall.
• can be associated with a shot 1st cuneiform.• can be responsible for metatarsalgia.• this syndrome may be complicated by stress fractures
of the 2nd and 3rd metatarsal shafts
PolydactylyPolydactyly
• an increase in the number of fingers and toes
Bilateral Bilateral Bipartite Bipartite
Sesamoid Sesamoid BonesBones
• most commonly involves the sesamoids at the 1st MTP joint
Tripartite Tripartite Medial Medial
Sesamoid Sesamoid of the of the 1st MTP1st MTP
• An area of lucencyarea of lucency that may be visualized within the anterior calcaneus
• due the the appearance of the normal trabecular patternnormal trabecular pattern
Heel SpursHeel Spurs
• Osteophyte formation at the insertion sites of the plantar plantar aponeurosis aponeurosis and the Achilles Achilles tendontendon
Duplication Duplication of the 1st of the 1st
DigitDigit of the Footof the Foot
BrachymetatarsiaBrachymetatarsia• usually involves the
4th metatarsal
• bilateral
• 25 times more common in females
Foot Lines of MeasurementFoot Lines of Measurement
Heel Pad ThicknessHeel Pad Thickness
• should not exceed 25 mm 25 mm in menin men or 23 23 mm in womenmm in women
Boehler’s Boehler’s AngleAngle
• the normal measurement is between 28 to 40 28 to 40 degreesdegrees
Review of Normal Foot and Review of Normal Foot and Ankle VariantsAnkle Variants
Normal Normal Variant ?Variant ?
Anomaly?Anomaly?
Normal Variant ?Normal Variant ?
Name of this Name of this Normal Normal
Appearance ?Appearance ?
Normal Variant ?Normal Variant ?
Normal Variant ?Normal Variant ?
• Tarsal Tarsal CoalitionCoalition
• a fibrous or osseous union between two tarsal bones
AbnormalityAbnormality
Normal Variant ?Normal Variant ?
Normal Variants?Normal Variants?
Thank YouThank You