Ankle (lateral view)
Updates to Article Attributes
Ankle lateral view is part of a three view ankle series, this projection is used to assess the distal tibia and fibula, talus, navicular, cuboid, base of the 5th metatarsal and calcaneus.
Patient position
- patient is in a lateral recumbent position on the table
- the lateral aspect of the knee and ankle joint should be in contact with the table resulting in the tibia
layinglying parallel to the table - the leg can be bent or straight
- foot in dorsiflexion
- place the opposite leg behind the injured limb to
helpavoid over rotation
Technical factors
- mediolateral projection
-
centring point
- the bony prominence of the medial malleolus of the distal tibia
- collimation
-
orientation
- portrait
-
detector size
- 18 cm x 24 cm
-
exposure
- 50-60 kVp
- 3-5 mAs
-
SID
- 100 cm
-
grid
- no
Image technical evaluation
The distal fibula should be superimposed by the posterior portion of the distal tibia.
The talar domes should be superimposed allowing for adequate inspection of the superior articular surface of the talus.
The joint space between the distal tibia and the talus is open and uniform.
Practical points
Superior-inferior malalingmenntmalalignment of the superior aspect of the talus is resultant of the tibia not layinglying parallel to the image receptor. To adjust this, either lower the knee to better match the ankle or place the ankle on a small sponge to better match the knee.
Anterior-posterior mal-alignmentmalalignment of the talar domes is due to over or under rotation of the foot. To adjust this, check the heel isn’t raised too far or alternately the toes, if the patient cannot correct this position it can be aided with a small wedge sponge. In trauma it may not possible to position the patient as above, in these cases the same principles can be applied with a modified horizontal beam view. The patient can remain supine with a image receptor placed vertically adjacent to the lateral aspect of the upright ankle, the X-ray beam is directed horizontally, centred at the bony prominence of the medial malleolus of the distal tibia.
-<li>the lateral aspect of the knee and ankle joint should be in contact with the table resulting in the tibia laying parallel to the table</li>- +<li>the lateral aspect of the knee and ankle joint should be in contact with the table resulting in the tibia lying parallel to the table</li>
-<li>place the opposite leg behind the injured limb to help avoid over rotation</li>- +<li>place the opposite leg behind the injured limb to avoid over rotation</li>
-<li>inferior to the skin margins of the planter aspect of the foot</li>- +<li>inferior to the skin margins of the plantar aspect of the foot</li>
-</ul><h4>Image technical evaluation</h4><p>The distal fibula should be superimposed by the posterior portion of the distal tibia.</p><p>The <a href="/articles/talus">talar domes</a> should be superimposed allowing for adequate inspection of the superior articular surface of the talus.</p><p>The joint space between the distal tibia and the talus is open and uniform.</p><h4>Practical points</h4><p>Superior-inferior malalingmennt of the superior aspect of the talus is resultant of the tibia not laying parallel to the image receptor. To adjust this, either lower the knee to better match the ankle or place the ankle on a small sponge to better match the knee. </p><p>Anterior-posterior mal-alignment of the talar domes is due to over or under rotation of the foot. To adjust this, check the heel isn’t raised too far or alternately the toes, if the patient cannot correct this position it can be aided with a small wedge sponge. <br><br>In trauma it may not possible to position the patient as above, in these cases the same principles can be applied with a <a href="/articles/modified-horizontal-beam-ankle">modified horizontal beam view</a>. The patient can remain supine with a image receptor placed vertically adjacent to the lateral aspect of the upright ankle, the X-ray beam is directed horizontally, centred at the bony prominence of the medial malleolus of the distal tibia. </p>- +</ul><h4>Image technical evaluation</h4><p>The distal fibula should be superimposed by the posterior portion of the distal tibia.</p><p>The <a href="/articles/talus">talar domes</a> should be superimposed allowing for adequate inspection of the superior articular surface of the talus.</p><p>The joint space between the distal tibia and the talus is open and uniform.</p><h4>Practical points</h4><p>Superior-inferior malalignment of the superior aspect of the talus is resultant of the tibia not lying parallel to the image receptor. To adjust this, either lower the knee to better match the ankle or place the ankle on a small sponge to better match the knee. </p><p>Anterior-posterior malalignment of the talar domes is due to over or under rotation of the foot. To adjust this, check the heel isn’t raised too far or alternately the toes, if the patient cannot correct this position it can be aided with a small wedge sponge. <br><br>In trauma it may not possible to position the patient as above, in these cases the same principles can be applied with a <a href="/articles/modified-horizontal-beam-ankle">modified horizontal beam view</a>. The patient can remain supine with a image receptor placed vertically adjacent to the lateral aspect of the upright ankle, the X-ray beam is directed horizontally, centred at the bony prominence of the medial malleolus of the distal tibia. </p>
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