radiographic assessment

radiographic assessment

Table 1 and Table 2, Figure 1
Table 1: Radiograph assessment - the logical, sequential and consistent method for interpreting a radiograph
FeatureCharacteristics
The technical quality of the radiograph
The quality of the imageDetail of structures
Contrast, allowing a clear profile of individual structures
Density variation so that all features of the image are clearly defined
Diagnostic review of the image: ABCDS approach
AlignmentBone alignment, apposition and angulation, joint congruity
  • The shape of each osseous component is view-dependent:

  • Lateral view: talus, calcaneum, navicular, first metatarsal

  • Dorsoplantar view: foot type (supinated/pronated), calcaneum, navicular, cuneiforms, fifth metatarsal, first metatarsal, hallux, phalanges

  • Mediolateral oblique view: cuboid, navicular, lesser metatarsals, first metatarsal

  • Axial view: sesamoids

ArchitectureInternal architecture: structure of cortex and trabeculae
External architecture: integrity of bone margins, subperiosteal surfaces, subchondral bone plate, fracture, sequestrum, involucrum, cloaca, accessory ossicles, Charcot joint, osteolysis, osteoarthritis, coalitions, osteochondritis, rheumatoid disease, tumours
Bone mineralizationIncreased density (sclerosis/eburnation), decreased density (osteoporosis, osteopenia, active osteomyelitis)
Cartilage spaceIncreased or decreased joint spaces
Distal to proximal examinationThe consistent method of radiograph evaluation
Soft-tissue evaluationCalcification or ossification of soft-tissue structures, arterial calcification, gouty tophus, oedema, infection
Table 2: Radiographic charting
AngleNormal rangeClinical features
Boehler's angle20-40°Angle between a line drawn from the superior-posterior aspect of the calcaneum and a line drawn from the anterior dorsal aspect of the calcaneum, on a lateral radiograph
Calcaneal inclination angleAngle between a line drawn to the undersurface of the calcaneum (on a lateral radiograph) and the support surface; the greater the calcaneal angle, the more supinated the rearfoot; the lower the angle, the more pronated the rearfoot
CYMA lineLazy S-shaped line that forms the midtarsal joint (talonavicular and calcaneocuboid joints) on a lateral radiograph; the smoothness of the CYMA line is lost in the excessively pronated or supinated foot
Hallux abductus angle0-20°Angle between the longitudinal bisection of the first metatarsal and the longitudinal bisection of the proximal phalanx of the hallux (on a dorsiplantar radiograph)
Hallux interphalangeal angle0-10°Angle between the longitudinal bisection of the proximal phalanx of the hallux and the longitudinal bisection of the distal phalanx of the hallux (on a dorsiplantar radiograph)
Lesser tarsal angle10°Angulation between the longitudinal bisection of the rearfoot and a longitudinal bisection of the lesser metatarsals (on a dorsiplantar radiograph). This angle is increased in a pronated foot, and decreased in a supinated foot
Metatarsus adductus angle10-20°Angle between the longitudinal axis of the second metatarsal and a line perpendicular to a line drawn from reference points on the medial cuneiform to the cuboid (on a dorsiplantar radiograph)
Metatarsus adductus primus angle8-10°Angulation between the bisections of the first and second metatarsal (on a dorsiplantar radiograph) >12° indicates pathology in a rectus foot; 10° indicates pathology in an adductus foot
Parallel pitch lines (PPLs)Lines drawn on a lateral radiograph of the foot: see Figure 2
PPL 1: a line drawn at the inferior margin of the calcaneum that joins the anterior tubercle and the medial tubercle of the posterior tuberosity of the calcaneum
PPL 2: a line drawn parallel to PPL 1 between the bursal projection (or posterior-superior prominence) at the superior margin of the calcaneum and the posterior lip of the talar articular facet
Divergent PPLs are characteristic of a foot with Haglund's deformity
Proximal articular set angle (PASA)0-8°Angle created between a line perpendicular to the longitudinal bisection of the first metatarsal and a line drawn to represent the effective articular cartilage of the head of the first metatarsal (on a dorsiplantar radiograph)
Superior calcaneal tuberosity angleAngle between the posterior tuberosity of posterior margin of the calcaneum and the anterior and medial tuberosities on the inferior margin of the calcaneum (on a lateral radiograph)
Talar declination angleAngle between the longitudinal bisection of the talus and the support surface (on a lateral radiograph); the nearer to the horizontal, the more supinated the rearfoot; the greater the declination of the talus, the more pronated the rearfoot (on a dorsiplantar radiograph)
Tibial sesamoid positionRelationship of the tibial sesamoid and the longitudinal bisection of the first metatarsal; the tibial sesamoid is normally medial to the first metatarsal bisection; christa erosion is likely where the tibial sesamoid abuts or crosses to the lateral part of the first metatarsal (on a dorsiplantar radiograph)
Total angle<75°Sum of the calcaneal inclination angle and superior calcaneal tuberosity angle see Figure 3

Biomechanical evaluation of plain radiographs is primarily made from dorsiplantar

Figure 1: Plantar fascia. MTP, metatarsophalangeal. This article was published in Neale's Disorders of the Foot, Lorimer, French, O'Donnell, Burrow, Wall. Copyright Elsevier, (2006).
Figure 2: Plantar fascia. MTP, metatarsophalangeal. This article was published in Neale's Disorders of the Foot, Lorimer, French, O'Donnell, Burrow, Wall. Copyright Elsevier, (2006).
Figure 3: Plantar fascia. MTP, metatarsophalangeal. This article was published in Neale's Disorders of the Foot, Lorimer, French, O'Donnell, Burrow, Wall. Copyright Elsevier, (2006).
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