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?

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