Toes (AP view)

Radiopaedia • CC-by-nc-sa 3.0 • de

Toes AP view is part of a three view toe series and includes the phalanges and the toe(s) of interest and the distal half of the associated metatarsals.

Indications

This view evaluates any joint abnormalities such as gout and osteoarthritis and is also useful in determining fractures or dislocations of all phalanges of a specified toe(s).

Patient position

  • the patient can be either supine or be sitting upright on the table
  • knee should be flexed so the plantar surface of the foot makes contact with the detector

Technical factors

  • AP projection
  • centering point
    • x-ray beam centered to the metatarsophalangeal joint in question
    • the beam is perpendicular to the detector
  • collimation
    • collimate to include toe(s) of interest and at least part of the toe either side laterally
    • anterior to the skin margins of the most distal toe(s) of interest
    • posteriorly include at least the distal half of the metatarsal(s)
  • orientation
    • portrait
  • exposure
    • 50-55 kVp
    • 2-4 mAs
  • SID
    • 100 cm
  • grid
    • no

Image technical evaluation

  • toe(s) of interest should be seen independently with no overlapping of soft tissues
  • no rotation should be present, the shafts of the phalanges and metatarsals should appear equal on either side

Practical points

The bases of the metatarsals are the most reliable rotation indicator on the AP view.

If the foot is over rotated externally, the metatarsal bases will be heavily superimposed.

Over rotation internally will open up the metatarsal bases. The resulting image will be a close resemblance to the medial oblique projection.

In trauma, the patient may not be able to flex the affected knee to the desired angle. In this case, a triangular wedge can be placed under the foot.