Reading Foot X-rays
A systematic look at the midfoot and forefoot.
Aug 31, 2026 · 3 refs
At a glance
Foot films are AP, oblique, and lateral — weight-bearing when they can stand. Lisfranc and the midfoot are the misses. Read proximal to distal: hindfoot, Chopart, Lisfranc, metatarsals, toes.
Technique pointers
AP / oblique
- Lisfranc interval (medial cuneiform–second metatarsal)
- Alignment of the second metatarsal with the middle cuneiform
- Fifth metatarsal zones (tuberosity vs Jones vs shaft)
- Lisfranc equivalent on the oblique
Lateral
- Talus-first metatarsal line
- Cuboid, navicular, posterior process of talus
- Soft-tissue swelling over the midfoot
Decision-making
A “sprained foot” with midfoot swelling and a tiny avulsion at the base of the second metatarsal is a Lisfranc until stress or CT says otherwise. Weight-bearing films are worth the extra minute.
High-yield / exam
- Weight-bearing when possible
- Lisfranc interval on AP and oblique
- Fifth metatarsal zone before you boot and street
- Hindfoot on the same series as the toes
Questions
Ortho Skills (Real Life) and Boards items for this topic are coming.
Your pearl
One line you’d tell a junior at 2am.
References
- 01
Radiographic evaluation of the ankle and foot
2013 · Journal of the American Academy of Orthopaedic Surgeons · review
Same systematic language as the ankle, continued through the midfoot.
- 02
AOFAS / AAOS teaching on Lisfranc radiographic evaluation
2016 · American Academy of Orthopaedic Surgeons (guidelines / AUC) · guideline
Weight-bearing AP and the second-metatarsal alignment are the Lisfranc tells.
- 03
OTA teaching on foot radiographic series and fifth-metatarsal zones
2019 · Orthopaedic Trauma Association · guideline
Zone of the fifth and the Lisfranc interval change tonight’s plan.
From the Journal
Films and cases live in the long-form. This Topic is the system.
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