Foot and ankle

Question 1

What is a good view of talar dome?

Answer 1

AP view of ankle

Question 2

Which view is good for mortise joint? What position is the leg in?

Answer 2

AP oblique view of ankle
- lower leg is in IR

Question 3

What is calcaneal inclination? What is normal?

Answer 3

line from bottom of calcaneus to bottom of metatarsals
- normal is 20-30 deg

Question 4

Pes cavus and pes planus angles

Answer 4

pes cavus - > 50 deg calcaneal inclination

pes planus - < 20 deg calcaneal inclination

Question 5

What is tarsal coalition? What view can this be seen in?

Answer 5

unions of bones in foot that are not normal
- seen in lateral view of the ankle

Question 6

Ottawa Ankle and Foot Rules

Answer 6

Ankle
- bone tenderness at posterior edge or tip of lateral malleolus OR
- bone tenderness at posterior edge or tip of medial malleolus OR
- inability to bear weight both immediately and in ED for 4 steps

Foot
- bone tenderness at base of 5th metatarsal OR
- bone tenderness at navicular OR
- inability to bear weight both immediately and in ED for 4 steps

Question 7

1st imaging study for suspected stress (fatigue) including sacrum, excluding vertebrae

Answer 7

x-ray

Question 8

Next imaging study for suspected stress (fatigue) fx, excluding hip and vertebrae, negative radiographs

Answer 8

• repeat x-ray in 10-14 days
• MRI

Question 9

What is a fatigue fx?

Answer 9

abnormal stress to normal bone

Question 10

Next imaging study for suspected stress (fatigue) fx, hip (non-lower leg), negative radiographs

Answer 10

MRI

Question 11

Next imaging study for suspected stress (fatigue) fx, excluding vertebrae, negative radiographs, immediate “need-to-know” diagnosis

Answer 11

MRI

Question 12

Follow-up imaging study for return to play eval for confirmed stress (fatigue) fracture, excluding vertebrae

Answer 12

MRI

Question 13

What is an insufficiency fx?

Answer 13

normal stress to abnormal bone

Question 14

Initial imaging for suspected stress (insufficiency) fx of lower extremity, excluding pelvis and hip

Answer 14

x-ray lower extremity area of interest

Question 15

Next imaging study for suspected stress (insufficiency) fx of lower extremity, excluding pelvis and hip, negative radiographs

Answer 15

• MRI
• x-ray repeat in 10-14 days

Question 16

Initial imaging of suspected stress (insufficiency) fx, pelvis or hip (non-lower leg)

Answer 16

x-ray

Question 17

Next imaging study of suspected stress (insufficiency) fx, pelvis or hip (non-lower leg), negative radiographs

Answer 17

• MRI
• CT

Question 18

Acute trauma to ankle - initial imaging for adult or child >/= 5 y/o w/ acute trauma to ankle w/ persistent pain for more than 1 week but less than 3 weeks, meet Ottawa Ankle rules (no exclusionary criteria)

Answer 18

radiography

Question 19

Acute trauma to ankle - initial imaging for adult or child >/= 5 y/o w/ acute trauma to ankle, negative Ottawa Ankle Rules (no exclusionary criteria present)

Answer 19

no imaging recommended

Question 20

Acute trauma to ankle - initial imaging for adult or child >/= 5 y/o w/ acute trauma to ankle, Ottawa Ankle Rules negative, not neurological intact

Answer 20

radiography

Question 21

acute trauma to the foot - initial imaging for adult or child >/= 5 y/o w/ acute trauma to foot, negative Ottawa Rules, no suspected abnormalities in regions not evaluated by Ottawa Rules

Answer 21

no imaging recommended

Question 22

acute trauma to the foot - initial imaging for adult or child >/= 5 y/o w/ acute trauma to foot, positive Ottawa Rules

Answer 22

• radiography foot
• radiography foot w/ weightbearing

Question 23

acute trauma to the foot - initial imaging for adult or child >/= 5 y/o w/ acute trauma to foot, negative Ottawa Ankle Rules, suspected pathology to area not addressed by Ottawa Rules (not involving the midfoot; metatarsal-phalangeal joint, metatarsal, toe, tendon, etc)

Answer 23

• radiography foot
• radiography foot w/ weightbearing

Question 24

chronic ankle pain - initial imaging

Answer 24

x-ray ankle

Question 25

chronic ankle pain - next study, chronic ankle pain, ankle radiographs normal, suspected osteochondral lesion

Answer 25

MRI

Question 26

What injury is there concern for talar dome osteochondral lesion that is not traumatic?

Answer 26

inversion ankle sprain

Question 27

chronic ankle pain - next study, chronic ankle pain, ankle radiographs normal or nonspecific, suspected tendon abnormality

Answer 27

- MRI - US

Question 28

chronic ankle pain - next study, chronic ankle pain, ankle radiographs normal, pain of uncertain etiology

Answer 28

MRI

Question 29

chronic foot pain - initial imaging, unknown etiology

Answer 29

radiography foot

Question 30

chronic foot pain - next imaging study, chronic plantar heel pain, radiographs negative or equivocal, clinical concern includes plantar fasciitis or plantar fascia tear

Answer 30

- US foot - MRI foot