Trauma X-ray - Lower limb
Foot

Foot

Fractures and dislocations of the forefoot (metatarsals and phalanges) are usually straightforward to identify, so long as the potentially injured bone is fully visible in 2 planes. The contour of the bone cortex of all bones must be checked carefully.

Standard views

Dorsal-Plantar (DP) and Oblique - are standard projections of the forefoot. If only a phalangeal fracture is suspected then DP and oblique views of the toe(s) can be acquired. Lateral views can also be helpful.

Foot ligament anatomy

When checking any post-traumatic foot X-ray it is crucial to assess alignment of the bones at the joints. Loss of joint alignment can represent severe injury, even in the absence of a fracture.

Lisfranc injury

The 'Lisfranc' ligament stabilises the mid-forefoot junction. Loss of alignment of the 2nd metatarsal base with the intermediate cuneiform indicates injury to this important ligament.

Every post-traumatic foot X-ray must be checked for loss of alignment at the midfoot-forefoot junction (tarsometatarsal joints).

Metatarsal fractures

Metatarsal fractures are usually easily recognised, but are often only visible on one view.

Fractures of the 5th metatarsal base are a common injury. The normal 5th metatarsal apophysis should not be mistaken for a fracture.

Metatarsal stress fractures

Stress fractures of the metatarsals are common in athletically active individuals. These may not be visible on initial X-rays but follow up images show periosteal stress reaction. This has the appearance of fusiform bone expansion.