This presentation provides a comprehensive overview of X-ray views used in radiology for assessing foot, calcaneus (heel bone), and ankle joint conditions. The presentation covers various X-ray techniques, and specialized views for injuries.

1. VIEWS FOR FOOT, CALCANEUM
AND ANKLE JOINT
Presented By: Ram Chand (220513019)
Course: MSc RIT (2nd SEMESTER)
Department: Radio-Imaging Technology
Faculty: Allied Health Sciences, SGT University, Gurugram

2. INTRODUCTION
A foot, ankle, and calcaneum X-ray is a diagnostic tool used
to assess the bones and joints in the lower leg and foot. It is a
safe and effective way to identify conditions or injuries that
may require treatment.

3. ANATOMY
Image Sources: Research gate, Pinterest

4. INDICATIONS
• foot trauma
• bony tenderness at the base of the metatarsal
• bony tenderness at the navicular bone
• inability to weight-bear more than four steps
• non-traumatic foot pain

5. PREPARATION
• Patient history is collected
• Patient is asked to remove all radiopaque materials
• Wear hospital gown
• Chaperone is necessary for female patient
• Shielding is provided to patient

6. FOOT SERIES
• Dorsoplantar view
• Medial Oblique view
• Lateral view

7. FOOT (DORSOPLANTER VIEW) POSITIONING
• the patient may be supine or
upright depending on comfort
• the affected leg must be flexed
enough that the plantar aspect of
the foot is resting on the image
receptor
Image Sources: Department of Radiology, Apollo Hospital, Bhubaneswar

8. TECHNICAL FACTORS
• centring point
• x-ray beam centred to the base of the 3rd metatarsal
• Orientation: Portrait
• detector size: 18 cm x 24 cm
• exposure
• 50-55 kVp
• 3-4 mAs
• SID: 100 cm
• Grid: no
Image Sources: Bontrager’s

9. FOOT MEDIAL OBLIQUE VIEW POSITIONING
• the patient may be supine or upright
depending on comfort
• the affected leg must be flexed enough
that the plantar aspect of the foot is resting
on the image receptor
• the foot is medially rotated until the
plantar surface sits at a 45° angle to the
image receptor
Image Sources: Department of Radiology, Apollo Hospital, Bhubaneswar

10. TECHNICAL FACTORS
• centring point
• x-ray beam centred to the base of the 3rd metatarsal
• the beam will be perpendicular to the image receptor
• Orientation: Portrait
• detector size: 18 cm x 24 cm
• exposure
• 50-55 kVp
• 3-4 mAs
• SID: 100 cm
• Grid: no
Image Sources: Bontrager’s

11. FOOT LATERAL VIEW POSITIONING
• the patient may be supine or upright depending on
comfort
• the affected leg is externally rotated until the distal limb is
parallel to the table, in many cases, the patient will have
to half roll onto the affected side
• the lateral aspect of the foot will be in contact with the
image receptor
• the non-affected side is kept posterior to prevent over
rotation
• the foot is in slight dorsiflexion
• the planter surface should be perpendicular to the image
receptor
Image Sources: Department of Radiology, Apollo Hospital, Bhubaneswar

12. TECHNICAL FACTORS
• centring point
• base of metatarsals or midfoot
• Orientation: Landscape
• detector size: 18 cm x 24 cm
• exposure
• 50-60 kVp
• 4-6 mAs
• SID: 100 cm
• Grid: no
Image Sources: Bontrager’s

13. CALCANEUM
SERIES
• Axial view
• Lateral view

14. AXIAL VIEW OF CALCANIUM POSITIONING
• The patient is seated on x ray table
with legs extended.
• Affected side ankle is dorsiflexed
placing the heel on the cassette.
• The patient is asked to hold the
ankle by the help of a bandage
cloth sling over the foot.
• Patient is immobilized side is
marked and beam is collimated.

15. TECHNICAL FACTORS
• centring point
• Middle sole of the foot
• Orientation: Portrait
• detector size: 18 cm x 24 cm
• exposure
• 50-60 kVp
• 3-5 mAs
• SID: 100 cm
• Grid: no
Image Sources: Bontrager’s

16. LATERAL VIEW OF CALCANIUM POSITIONING
• The patient is seated on x ray table
with legs extended.
• Recumbent, on affected side, knee
flexed with unaffected limb behind,
to prevent over-rotation
• Place support under knee and leg
as needed for a true lateral
• Dorsiflex foot so the plantar surface
is near 90° to leg if possible.

17. TECHNICAL FACTORS
• centring point
• Mid calcaneus, inferior to medial malleolus
• Orientation: Portrait
• detector size: 18 cm x 24 cm
• exposure
• 50-60 kVp
• 3-5 mAs
• SID: 100 cm
• Grid: no
Image Sources: Bontrager’s

18. ANKLE SERIES
• AP view
• Lateral view
•Special projections
• Mortise view
• Stress view

19. ANKLE AP VIEW POSITIONG
• the patient may be supine or sitting
upright with their leg straighten on the
table
• the foot is in dorsiflexion
• the toes will be pointing directly
toward the ceiling
Image Sources: Department of Radiology, Apollo Hospital, Bhubaneswar

20. TECHNICAL FACTORS
• centring point
• the midpoint of the lateral and medial malleoli
• Orientation: Portrait
• detector size: 24 cm x 30 cm
• exposure
• 50-60 kVp
• 3-5 mAs
• SID: 100 cm
• Grid: no
Image Sources: Bontrager’s

21. ANKLE LATERAL VIEW POSITIONG
• patient is in a lateral recumbent position on the
table
• the lateral aspect of the knee and ankle joint
should be in contact with the table resulting in the
tibia lying parallel to the table
• the leg can be bent or straight
• foot in dorsiflexion
• place the opposite leg behind the injured limb to
avoid over-rotation
Image Sources: Department of Radiology, Apollo Hospital, Bhubaneswar

22. TECHNICAL FACTORS
• centring point
• the bony prominence of the medial malleolus of the distal tibia
• Orientation: Portrait
• detector size: 18 cm x 24 cm
• exposure
• 50-60 kVp
• 3-5 mAs
• SID: 100 cm
• Grid: no
Image Sources: Bontrager’s

23. SPECIAL PROJECTIONS
MORTISE VIEW STRESS VIEW
This projection is use to assess the
articulation of the Tibial Plafond and tow
Malleoli with the Talar Dome
Stress view is important in the evaluation of
the Ligamentous Tears, joint stability and
fracture unions
Image Sources: Bontrager’s

24. ANKLE MORTISE VIEW POSITIONG
• the patient may be supine or sitting upright with
the leg straightened on the table
• the leg must be rotated internally 15° to 20°, thus
aligning the intermalleolar line parallel to the
detector. This usually results in the 5th toe being
directly in line with the centre of the calcaneum
• internal rotation must be from the hip; isolated
rotation of the ankle will result in a non-diagnostic
image
• foot should be in slight dorsiflexion
Image Sources: Bontrager’s

25. TECHNICAL FACTORS
• centring point
• the midpoint of the lateral and medial malleoli
• Orientation: Portrait
• detector size: 24 cm x 30 cm
• exposure
• 50-60 kVp
• 3-5 mAs
• SID: 100 cm
• Grid: no
Image Sources: Bontrager’s

26. ANKLE STRESS VIEW POSITIONG
• the patient may be supine or sitting
upright with the leg straightened on the
table
• the leg must be rotated internally 15° to
20°
• the second person (often requesting
physician) will then place the ankle into
supination and external rotation
Image Sources: Bontrager’s

27. TECHNICAL FACTORS
• centring point
• the midpoint of the lateral and medial malleoli
• Orientation: Landscape
• detector size: 24 cm x 30 cm
• exposure
• 50-60 kVp
• 3-5 mAs
• SID: 100 cm
• Grid: no
Image Sources: Bontrager’s

28. BIBLIOGRAPHY
https://courseware.cutm.ac.in/teachers/sambangi-
satyananda-shiva-sagar/
https://radiopaedia.org/articles/
Bontrager’s HANDBOOK OF RADIOGRAPHIC POSITIONING AND
TECHNIQUES
FOOTNOTES
Disclosure. This topic is more often based on the practical
aspects under authorized personnel.

29. QUESTIONS
Can you identify the following figure positionings?
A B
Image Sources: Department of Radiology, Apollo Hospital, Bhubaneswar

30. QUESTIONS
What is Tibial Plafond?
Image Sources: Bontrager’s
A tibial plafond fracture (also known as a pilon fracture) is a fracture of the
distal end of the tibia

31. THANK
YOU