Systematic Way to Read Foot Xrays

Here we go. Foot xrays. There are alot of details that could be discussed here. This is a good starting point.

Commonly in three views. AP, oblique and lateral. Shown below in order.

Remember:

• Say what views you are seeing.

• Look for open growth plates and say whether the image is skeletally mature or immature

• Describe the most correct and straight to the point pathology you are seeing

• From our experience it is better if you don’t offer up too much detailed information

• Start with straightforward and simple, yet thorough and accurate.

First, scan the whole image and find what you can.

Then work systematically.

• Start proximally and work distally

• The lateral view is particularly good at viewing the more proximal joint spaces, talus, and calcaneus

• Look at tibiotalar joint

• Subtalar joint

• Talonavicular joint

• Outline the cortices of the talus, calcaneus, and navicular bones

  
  

• For each view: AP, lateral, and oblique work proximal to distal

• Outline the tarsal bone cortices and joints

• Outline the Metatarsal bone cortices and joints

• Phalange cortices and joints

  
  

• On all views check the area of the Lis Franc Ligament

• The Lis Franc Ligament attaches the Medial cuneiform and base of 2nd metatarsal

• It has a dorsal aspect (weakest portion), interosseous (Strongest portion), and plantar aspect

  
  

• 
  

  Then check for your specific lines if an injury is not obvious

  
  

On AP view

• Look for widening between the 1st and 2nd ray (1st and 2nd metatarsal)

• Check that medial border of 2nd metatarsal and medial border of intermediate cuneiform should line up

• Look for fleck sign: Bone fragment in 1st intermetatarsal space

  
  

Credit: Orthobullets

On Oblique View:

• Medial borders of 3rd metatarsal and lateral cuneiform should line up on the oblique view

• Medial side of base of 4th metatarsal with medial side of cuboid

  
  

Lateral view

• Look for dorsal displacement of proximal base of the 1st or 2nd metatarsal

• The base of 1st and 2nd metatarsal should line up with the dorsal aspect of the carpal bones

Credit: Orthobullets