Lower Limb

1
Lower Limb

• 29 August 2006

2
DP (AP) Toes

• Position
• Seated or supine on table
• CP 3rd metatarsophalangeal joint
• CR Perpendicular (non joint demonstration) nor
  15 degrees to ankle if joint visualisation
  required

3
Evaluation

• No rotation
• Open joint spaces on angled view
• Toes separate
• Distal end of metatarsals seen
• Soft tissue and trabecular seen

4
Oblique Toes

• Position
• As for DP
• CP 3rd metatarsophalangeal joint
• CR perpendicular

5
Evaluation

• All phalanges
• Oblique toes
• Open interphalangeal and 2-5th metatarsophalangeal
  joint spaces
• Toes separated

6
Lateral toes -positions vary according to which
toe
7
Evaluation

• Phalanges in profile
• No superimposition of phalanges
• Open joint spaces

8
DP Foot

• Position
• Patient supine
• Flex knee to place plantar surface on table
• CP base of 3rd metatarsal
• CR 10 degrees towards ankle (heel)

9
Evaluation

• No rotation
• Equal space between adjacent mid shafts of 2-4
  metatarsals
• Overlap of 2-5 metatarsal bases
• See phalanges, metatarsal and tarsals distal to
  talus

10
Oblique Foot

• Position
• As for DP with leg rotated medially until plantar
  surface forms angle of 30 degrees to IR
• CP base of 3rd metatarsal
• CR perpendicular

11
Evaluation

• 3-5 metatarsal bases free of superimposition
• Lateral tarsals with less superimposition than DP
• Lateral tarsometatarsal and intertarsal joints
  seen
• Tuberosity of 5th metatarsal seen

12
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13
Lateral foot (medio lateral)

• Position
• Lying on table turned to affected side with leg
  and foot lateral
• Opposite leg behind patient
• Support under knee
• Dorsi flex foot 90 degrees to lower leg
• CP base of 3rd metatarsal
• CR Perpendicular

14
Evaluation

• Metatarsals nearly superimposed
• Distal leg
• Fibula overlapping posterior tibia

15
Axial sesamoids (Lewis method)

• Patient prone
• Elevate ankle
• Great toe dorsiflexed
• Ball of foot perpendicular to horizontal plane
• CP 1st Metatarsophalangeal joint
• CR Perpendicular

16
Evaluation

• Sesamoids clear 1st metatarsal
• Metatarsal heads

17
Axial sesamoids (Holly method)

• ? More comfortable for patient

18
AP Ankle

• Supine with limb fully extended
• Place foot in true AP position
• Dorsi-flex ankle and foot to vertical
• CPmidway between malleoli
• CR perpendicular

19
Evaluation

• Tibiotalar joint
• Overlapping tibiofibular articulation with talus
  (slightly overlapping distal fibula)
• Both malleoli

20
AP mortise ankle

• As for AP but with medial rotation
• Both malleoli equidistant from IR
• CP between malleoli
• CR perpendicular

21
Evaluation

• Entire ankle mortise joint

22
Oblique ankle

• As for AP ankle but the entire lower leg is
  medially rotated to a 45 degree position
• CP midway between malleoli
• CR perpendicular

23
Evaluation

• Distal tibia, fibula and talus seen
• Tibiofibular articulation

24
Lateral ankle

• Supine patient turns to affected side until ankle
  is lateral
• Dorsi-flex foot
• CP medial malleolus
• CR perpendicular

25
Evaluation

• Fibula over posterior part of tibia