Toes x-ray is prescribed if dislocations and fractures of the phalanges of the fingers are suspected. Depending on the nature of the injury, radiographs of one, two or all toes are produced. The standard examination is performed in two projections (usually straight and oblique). With standard radiography of one finger in traumatology, straight and oblique or straight and lateral images are taken. For a radiograph in a direct projection, the patient is placed on his back with his legs bent at the knees, while the soles rest on the surface of the table. The laying of the patient for oblique and lateral images of all fingers is carried out in the same way as with radiography of the foot.
Indications
Toes x-ray is indicated in the following cases:
- The patient complains of soreness in the foot area. Pain can manifest itself when walking, after a long load or at rest.
- Deformity of the foot. Most often occurs in the area of the metatarsophalangeal joint and is characterized by a violation of the location of the phalanges of the thumb in relation to each other. Such a curvature leads to the appearance of a bump on the outside of the foot and becomes not only a cosmetic defect, but also brings a lot of unpleasant sensations and limitations.
- Inflammation and infection of bones and joints (arthritis, arthrosis, etc.).
- Mechanical injuries of the foot (bumps, bruises, fractures).
- Flat feet.
- Congenital pathology of foot development.
The number of pathologies that can be detected by X-ray in two projections includes:
- arthritis and arthrosis;
- gout;
- flat feet of various degrees;
- heel spur;
- valgus deformity of the big toe.
Preparation
Preliminary preparation for toes x-ray is not required. However, there is one condition – the patient in front of her must remove jewelry and accessories made of metal located in the study area. To protect the patient from excessive radiation, special lead aprons are applied to the parts of the body that are not subject to examination.
Methodology of conducting
Toes x-ray in two projections
Toes x-ray in two projections are most often prescribed for the diagnosis of fractures, as well as deforming pathologies, such as arthritis or arthrosis. Also, this method of research makes it possible to assess changes in the thumb joint in gout. To shoot in a direct projection, the patient lies down on the table of the X-ray machine, stretches his legs forward. A picture is taken of two feet at the same time, even if alarming symptoms are noted only in one. To shoot in a side projection, the patient needs to turn over on his side. The radiologist positions the tube of the X-ray machine so that the rays pass perpendicular to the lateral surface of the foot.
For a more detailed study, pictures can be taken in other projections:
- Oblique. X-rays should pass through the foot at an angle of 45 degrees.
- Back-plantar. The tube of the device is installed so that the X-rays pass vertically to the surface of the foot. During the procedure, the patient bends the lower leg of the leg being examined slightly back.
Toes x-ray with a load
Toes x-ray with a load (as it is done, will be described below) allows you to obtain data on the features of the structure and anatomy of the joints. Usually, such a research technique is used in cases of suspected flat feet in children. Indications for performing an X- ray examination with a load are:
- anomalies of the osteoarticular system;
- the need to diagnose forms of flat feet;
- various deformities of the foot.
To get a high-quality image, the patient needs to stand on the X-ray cassette with one foot. At the same time, the second leg should remain in the air. To complete the picture, the image is made in two projections and for both legs. When the patient undergoes the prescribed course of treatment, the study is repeated.
Interpretation
To understand what the toes x-ray shows, first of all, a radiologist should. He does not make preliminary diagnoses, but simply describes the anatomical features of the foot bones. The task of the radiologist is to identify fractures, neoplasms, foci of inflammation and other deviations from the norm. Based on the description of the image, the diagnosis will be made by the attending physician – surgeon, orthopedist, oncologist or others.
Normally, an X-ray of a healthy person’s foot should visualize bones that are homogeneous in structure, the integrity of which is not violated. The contours of the bones should be uniform and clear, without darkening.
Symptoms of flat feet
To detect flat feet, an toes x-ray is usually performed with a load in the lateral projection. To do this, the foot is placed on the stand with the inner side to the X-ray cassette. The other leg is pulled aside. With this laying, three features are noted in the pictures:
- I – passes from the first finger to the heel bone;
- II – runs from the point of junction of the calcaneus with the first line to the navicular-wedge joint;
- III – passes from the same joint to the first metatarsal bone.
Correlating these lines, measure the height and angle of their intersection. The height is the perpendicular lowered from the junction point of the second and third lines down to the first horizontal one. Normally, the height should be greater than 35 mm, and the angle should be from 125 to 130 °. Deviation from these norms indicates the presence of flat feet. To identify the degree of pathology, it is necessary to assess how much the actual parameters of the foot differ from normal ones:
- I degree. The height of the arch is 25-35 mm, the angle is 131-140 °. With this pathology, the patient is concerned about fatigue in the legs during physical exertion.
- II degree. The height of the arch is 17-24 mm, the angle is 141-155 °. In this case, the patient feels increased pain with prolonged walking and physical effort.
- III degree. Height – less than 17 mm, angle – more than 155 °. With this pathology, the patient constantly feels pain in the lower legs, lower back and feet.
Injuries and fractures
Fractures and cracks on the toes x-ray are visualized as small elongated darkening with uneven contours. Based on the image, you need to assess exactly where the fracture line or cracks are located, whether there are fragments, whether their displacement takes place. To clarify the localization of the fracture, in addition to X-rays, an external examination is also performed, the foot is palpated. At the site of the fracture, when pressed, the patient feels acute pain.
Contraindications
During toes x-ray, the patient’s body is subjected to minimal radiation load. There are no absolute contraindications to toes x-ray, but in some cases the appointment should be done with caution. This applies to pregnant women, as well as children under the age of 15.
