8. Dome of the talus:
centered under and
congruous with tibial
plafond
Posterior malleolus
fractures & direction
of fibular injuries can
be identified
Avulsion
fractures of the
talus by the
anterior capsule
can be identified
9. Neutral triangle
Bone quality
Bohler’s Angle
20-40 degrees
Can be depressed
in both intra and
extra articular fx
Limited usefulness
10. Crucial angle of
Gissane
Dense cortical bone
margins of the STJ
Reconstitution is a
must for calcaneal
fractures
19. Foot is plantar
flexed, 15 degree
pronated and the
beam is angled 15
degree toward the
head
It shows the medial
column along the
talar head and neck
22. Talo-First MT line
(Normal = 0
degrees)
Hallux valgus
Talonavicular
Coverage Angle
(Normal = 0-7
degrees)
Useful for planning of
treatment forAAFD
23. Lateral border of 1st
metatarsal is aligned with
lateral border of 1st
(medial) cuneiform
Medial border of 2nd
metatarsal is aligned with
medial border of 2nd
(intermediate) cuneiform
24. Medial border
of 4th
metatarsal
aligned with
medial border
of cuboid
Medial and lateral
borders of the 3rd
(lateral) cuneiform
should align with
medial and lateral
borders of 3rd
metatarsal
Lateral margin of
the 5th
metatarsal can
project lateral to
cuboid by up to
3mm on oblique
view
26. IM space
between 1st and
2nd metatarsals
is equal to space
between the
medial and
middle
cuneiforms
27. • The medial cuneiform-second MT space should
be evaluated for the "fleck sign" indicating
avulsion of the Lisfranc ligament.
29. Talo-First MT line
(a.k.a Meary’s line)
Normal = 0
degrees
Useful for analysis
for treatment of
AAFD
30. LateralView
Superior border of
second metatarsal
is continuous with
superior border
second cuneiform
No dorsal nor
plantar
displacement of
metatarsal bases
52. Stress
radiography is
gold standard
for detection of
ankle instability
Anterior drawer
test
Talar tilt test
Stress views
Performed by
tilting the hindfoot
and looking for a
suction sign or
asymmetric
movement.
Positive stress test :
talar tilt > 15 degrees
side to side diff of 10
.
Ankle in 20 degree of
plantar flexion
The tibia is pushed
posteriorly against the
fixed foot
positive test - >0.5 to1
cm or side to side diff
of 3 mm
53. Ankle off the
edge of table
Rotated
externally
Let it fall
Cross table view
Deltoid
incompetence
Gravity Stress views
58. CT Scan
Axial cuts across
tibiofibular interval
Axial cuts at ankle
mortise
Reduction
Widening
Rotation
Fibular clear space
59. Axial cut 1 cm
above joint
Line from flat
anterolateral
surface of fibula to
anterior tubercle of
tibia
Must be within
2mm from anterior
surface of tibia
Most reliable CT sign!
60. USG: Advantages
Most effective for superficial structures like
tendons & ligaments
Dynamic
Allows for direct palpation of painful areas
during imaging
Comparison with opposite side
Easy & cheap
User dependent
Inadequate joint visualization
Poor osseous visualization
65. Plantarflexion: gap
in Achilles tendon
narrows to less
than 1 cm
Dorsiflexion:
gap
widens to
more than 2
cm
Achilles longitudinal
Achilles longitudinal
67. --Anterior tibial tendon (yellow arrowhead) impinged by screw head
(lg. white arrow) with fluid/synovitis (sm. arrows)
-
69. Tissue T1 T2
Cortex Low Low
Ligaments Low Low
Articular cart Intermed Intermed
Red marrow Intermed Intermed
Old blood High High
Osteomyelitis Low High
Sarcoma Low High
Marrow edema Low High
Fat High Intermed
Pus Intermed High