Foot - Lateral

Radiographic Positioning

Adult

Other related pages of interest Applied Radiography Radiographic Anatomy Radiographic Protocols

Name of projection	Foot - Lateral (mediolateral or lateromedial)
Area Covered	Entire foot - distal phalanges to the calcaneus and proximal ankle joint
Pathology shown	Fractures, degree of anterior or posterior displacement of fractures, foreign bodies, effusions
Radiographic Anatomy	Foot Radiographic Anatomy
IR Size & Orientation	24 x 30cm Landscape
Film / Screen Combination	Detail (CR and DR as recommended by manufacturer)
Bucky / Grid	No
Filter	No
Exposure	60 kVp 4 mAs
FFD / SID	100cm
Central Ray	Centered to the base of the metatarsals Perpendicular to IR
Collimation	Outer skin margins of foot to include proximal ankle
Markers	Superior to dorsal surface Marker orientation AP
Shielding	Gonadal (check your department's policy guidelines)
Respiration	Not applicable
Positioning	Patient is supineon the X-ray table or barouche Turn patienttoward affected side until leg and foot are lateral The lower leg should be parallel to the table in most cases, however if not, then the foot and IR can be elevated on sponges to achieve this desired position Keep the other leg behind to prevent over rotation Ask the patient to dorsiflex their foot, if possible, so that the plantar surface is at 90° to the lower leg. (This will best show the anterior pretalar fat pad) Plantar surface of foot is perpendicular to IR Place the IR under the foot so that the midline is parallel with the long axis of the foot Centre to the base of the metatarsals
Critique PACEMAN	Positioning The correct lateral position is evidenced by Metatarsals should be nearly superimposed Fibula overlapping the posterior portion of distal tibia Tibiotalar joint demonstrated The domes of the talus are superimposed Area Covered Entire foot should be demonstrated to show distal phalanges to the calcaneus proximal ankle joint 2.5cm of distal tibia/fibula soft tissue of the foot Collimation Centre: The base the metatarsals Shutter A: Open to include 2.5cm of the tibia and soft tissue of the sole of the foot Shutter B: Open to include the soft tissues of the toes and the heel Exposure Enough density to demonstrate the superimposed tarsals and metatarsals soft tissues are shown bony trabecular patterns and cortical outlines are well defined correct contrast and density to show the fat pads of the foot and ankle (posterior pericapsular and anterior pretalar fat pads)
Special Notes	The effect of incorrect lower leg angle i.e. Lower leg not being parallel to table Talar domes will not be superimposed, one will show more superior to the other. If the proximal tibia is higher than the distal tibia then the lateral talar dome will appear higher (more proximal) than the medial talar dome. If the distal tibia is higher than the proximal tibia then the medial talar dome will appear higher (more proximal) than the lateral talar dome. Tibia talar joint will not show open The effect of poor foot positioning i.e. Lateral foot surface not being parallel to IR Talar domes will not be superimposed, one will show more anterior to the other. If the leg and foot are externally rotated too far (that is, the heel is raised too far) then the medial talar dome is more anterior than the lateral talar dome. If the toes are raised too much (that is, the heel lateral heel is pressed against the IR) then the lateral talar dome is more anterior than the medial talar dome. Tibia talar joint will not show open