Normal Foot Xray
Xrays are basic investigations for orthopedic problems. To find the abnormal one must have an idea of normal.
This is how an normal foot x-ray looks like. The present image shows an anteroposterior and oblique view xray of left foot.
On left side of the plate there is an oblique view xray of the foot. On right side there is anteroposterior view.
Xray of the foot is ordered in various ailments of foot including trauma. Anteroposterior and oblique views are most common views that are ordered in foot. Anteroposterior views are also called dorsoplantar views.
Other view that is commonly done in addition to these views is lateral view.
Here is a video that demonstrate how foot xray views are taken. In the video xray of right foot are being shot.
What to Look For in Normal Foot Xray?
Normal foot can be divided into three different regions
- Forefoot – It consists of phalanges[toes] and metatarsals
- Midfoot – It has navicular, cuboid and three cunieforms namley medial, intermediate and lateral
- Hindfoot: Talus and Calcaneus
Bones of the midfoot and hindfoot are referred to as the tarsal bones
Following xray shows location of these bones on xray.
Anteroposterior or dorsoplantar view is very good for visualizing medial elements – first and second metatarsal bones, medial and intermediate cuneiforms and medial articulation of Lisfranc joint.
In a normal anteroposterior foot xray, interphalangeal joints are obscured but metatarsophlangeal joints are well seen and each joint should be checked. All the parts of ray – metatarsal and phalanges are well aligned.
Sesmoid bones in first toes are normal finding.
Head , neck and shaft of metatarsals are clearly visualized but bases blur.
Lisfranc joint is another name for tarsometarsal joint. In this joint, first, second, and third cuneiforms, and the cuboid, articulate with the bases of the metatarsal bones. The bones are connected by dorsal, plantar, and interosseous ligaments.
Lisfranc joint is very important for stability and subtle injury if missed can lead to problems. A normal Lisfranc joint is characterized by
– Medial borders of second metatarsal and intermediate cuneiform should be in line on anteroposterior xray.
– Medial borders of 3rd metatarsal and lateral cuneiform should line up on the oblique view.
Oblique View enables to clearly visualize 3rd, 4th and 5th metatarsals, lateral cuneiform, navicular and cuboid.
Phalanges and interphalangeal joints are better visualized in oblique xrays. Base of fifth metatarsal [site for Jones’s fracture] and tarsometatarsal aligment should be checked. As noted in antreposterior xray, for tarsometarsal joints to be normal medial margins of tarsal bone and respective metatarsal should be aligned. Finally the lateral tarsals and calcaneum should be analyzed. Oblique view xray of foot also gives an opportunity to have second look at the navicular bone.
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