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A foot and ankle x-ray is a painless test that uses a safe amount of radiation to make an image of these structures. During the examination, an x-ray machine emits x-rays through the foot and the image is recorded on a special x-ray film or computer. This image shows the soft tissues and bones of the foot, which includes the bones of the lower leg (peroneal and tibial bones and the talus, which together make up ankle), metatarsals (forefoot), and phalanges (toes).
The x-ray image is black and white. Dense structures that block X-rays, such as bones, appear white. Softer tissues, such as muscles, allow X-rays to pass through and appear darker.
A radiologist in the radiology department of a hospital supervises the performance of x-rays. Three different images of the foot are usually taken: one from the front (anteroposterior view), one from the side (side view), and one at an angle (oblique image).
Foot and ankle anatomy
The foot is a flexible structure of bones, joints, muscles, and soft tissues that allows you to stand upright and perform activities such as walking, running, and jumping. The forefoot contains five toes (phalanges) and five longer bones.
The midfoot is made up of pyramidal bones that form the arches of the legs. These include the three cuneiform bones, the cuboid bone, and the navicular bone.
The back of the foot forms the heel and ankle. The talus supports the bones of the lower leg (tibial and fibula), forming the ankle. The heel bone is the largest bone in the foot.
Muscles, tendons and ligaments run along the surfaces of the feet, allowing complex movements. The Achilles tendon connects the heel to the calf muscle and is essential when running, jumping, and standing on your toes.
The ankle joint allows you to move your foot up and down. The subtalar joint sits below the ankle joint and provides lateral movement of the foot.
Numerous ligaments (made of tough, movable tissue) surround the true ankle and subtalar joints that connect the bones of the foot to each other.
Indications for the study
Without a doubt, osteoarthritis is the most common disease of the foot, primarily due to mechanical wear and tear, the weight-bearing effect on the cartilage. However, this site is not uncommon for inflammatory rheumatic diseases (rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and Reiter’s syndrome), often first appearing or being diagnosed in the lower extremities. In addition, gouty arthritis and diabetic neuropathic osteoarthropathy often amaze rate.
Diagnosis of neoplasms of the foot using x-rays
At the distal leg sometimes there are single neoplasms in the bone. Fortunately, most of these neoplasms are benign. For example, a single bone cyst, enchondroma.
Some lesions are characteristic radiological peculiarities. Howeversome some of them are similar to others and may not be able to be distinguished by X-ray alone.
To evaluate these lesions, it is necessary to recognize the radiographic characteristics. These data can be used not only as diagnostic clues, but also to determine the growth rate or aggressiveness of the lesion.
A list of potential differential diagnoses can then be formulated based on these findings.
Diagnosis of foot fractures
Medical dictionaries define a fracture simply as the breaking of a bone. However, the clinician must also know the anatomical location of the fracture, its direction, and whether it is linear, comminuted, and distinguish it from a dislocation.
The biomechanics of different fractures can vary, and depending on this, the speed and type of union differ.
An x-ray of the foot is the best method for screening and determining the presence of a fracture. X-ray reveals changes that describe the type of fracture and the position of bone fragments.
Fractures that are difficult to visualize may require additional investigations such as computed tomography or radioisotope skeletal imaging.
Indications for an x-ray of the foot and ankle:
- fracture;
- neoplasms;
- flat feet;
- osteoarthritis;
- rheumatoid arthritis;
- psoriatic arthritis;
- Reiter’s syndrome;
- ankylosing spondylitis;
- neuropathic osteoarthropathy;
- septic arthritis.
Forefoot fractures and dislocations are usually easy to identify if the potentially damaged bone is fully visible in two planes. The cortical contour of all bones should be carefully examined.
Dorsal plantar and oblique – standard projections of the forefoot. If only a fracture of the phalanges is suspected, dorsal and oblique projections of the fingers may be obtained. Lateral projections can also be helpful.
If the patient has such complaints, an x-ray of the foot and ankle joint may be prescribed:
- periodic pain in the foot area, especially if this pain is not preceded by any physical activity, for example, long walking, long staying in a standing position patient, lifting heavy objects, uncomfortable shoes.
- changes in the appearance of the foot – a violation of the size, shape, color of the skin;
- the presence in the patient’s life history of frequent injuries, such as various fractures, dislocations, hematomas, sprains;
- the patient has risk factors for the development of diseases associated with the musculoskeletal system, for example, certain sports, obesity, genetic predisposition.
A foot x-ray can help find the cause of common signs and symptoms, such as pain, tenderness, numbness, swelling, or deformities. It can detect a broken bone or a dislocated joint.
Once a broken bone is established, x-rays can help determine if the bones are in the correct position and have healed properly.
If surgery is required, an x-ray may be taken to plan the operation and evaluate the results of the operation. In addition, x-rays can help detect cysts, tumors, and advanced bone infections.
Preparation for the study and the procedure
A foot X-ray does not require special preparation. The patient should remove clothing (including shoes), jewelry, or any metallic objects that may interfere with the image.
The developing fetus is more sensitive to the effects of radiationthan an adult, which means at greater risk of harm from x-ray examinationtherefore, if the patient is pregnant, the doctor should be informed.
Although the procedure may take about 15 minutes or longer, the actual exposure is usually less than a second.
The patient enters a special room, which will likely contain a table and a large x-ray machine hanging from the ceiling.
Parents can usually come with their child to ensure their peace of mind. Companions will need to wear a special protective apron to protect certain parts of the body.
The X-ray laboratory assistant positions the patient both on the table and outside it to take the required position. Then he goes behind the wall, or into the next room to control the machine.
Three x-rays usually are carried out front, side, and angle, so the technician will come back to reposition the leg for each new exposure. Sometimes doctors ask for x-rays of the opposite leg for comparison.
Getting Results
The patient will not feel anything during the x-ray. The x-ray room may be cool due to the air conditioner used to keep the normal operation equipment.
The positions required for x-rays can be uncomfortable, but they only need to be held for a few seconds.
If the patient is injured and cannot remain in the required position, the technologist can find another position that is easier for him.
A radiologist is a doctor specially trained to interpret x-ray images. It is he who will view the x-rays of the patient.
After evaluating the results, the radiologist will send a report to the attending physician, who will discuss with the patient what display received pictures and explain what it means.
In emergency cases, the results of the x-ray can be quickly available. And usually results are prepared in 1-2 days. In most cases, the results can be given directly to the patient or family at the time of the study.
Foot and ankle x-ray risks
In general, x-rays are safe. While there is little risk to the body with any exposure to radiation, the amount of radiation used in a foot x-ray is not considered dangerous. REntgenologists use the minimum amount of radiation necessary to obtaining reliable results.