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.


  • 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

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