Radiographic Positioning Techniques

Below are images of the more common foot and ankle positioning techniques with sample radiographs.

  • DP Foot
  • Lateral Foot
  • Medial Oblique Foot
  • Lateral Oblique Foot
  • Sesamoid Axial View
  • Calcaneal Axial View
  • AP Ankle
  • Mortise View
  • Medial Oblique Ankle
  • Lateral Oblique Ankle
  • Lateral Ankle
DP View

Image Receptor: flat on orthoposer

Foot Position: flat on image receptor

Tube Head Position: 15 degrees from vertical

Central Ray: directed to 2nd metatarsal-cuneiform joint

lateral view

Image Receptor: vertical in orthoposer slot

Foot Position: flat on orthoposer, medial side of foot against image receptor

Tube Head Position: 90 degrees from vertical

Central Ray: directed to cuboid

Medial Oblique View

Image Receptor: flat on orthoposer

Foot Position: medial side of foot is placed against image receptor with the leg turned inward such that the lateral sole of the foot is angled 45 degrees away from the image receptor. The foot should be perpendicular to the leg.

Tube Head Position: 0 degrees from vertical

Central Ray: directed to 3rd metatarsal-cuneiform joint

lateral oblique view

Image Receptor: flat on orthoposer

Foot Position: lateral side of foot is placed against image receptor with the leg turned outward such that the medial sole of the foot is angled 45 degrees away from the image receptor. The foot should be perpendicular to the leg.

Tube Head Position: 0 degrees from vertical

Central Ray: directed to 1st metatarsal-cuneiform joint

Sesamoid Axial View

Image Receptor: flat on orthoposer

Foot Position: standing on axial poser device which raises the heel and dorsiflexes the toes at the MPJs such that the sesamoids are lower than rest of foot

Tube Head Position: 90 degrees from vertical

Central Ray: directed at the sesamoids (back of the axial poser device)

Calcaneal Axial

Image Receptor: flat on orthoposer

Foot Position: flat on image receptor but dorsiflexed at ankle (aka "ski jump position")

Tube Head Position: 20 or 40 degrees from vertical

Central Ray: directed at the back of the talus

AP Ankle

Image Receptor: vertical in orthoposer

Foot Position: back of foot (heel) is placed against image receptor so that the toes point straight ahead

Tube Head Position: 90 degrees from vertical

Central Ray: directed at the center of the ankle joint

Mortise

Image Receptor: vertical in orthoposer

Foot Position: back of foot (heel) is placed against image receptor; the extremity is internally rotated (approximately 15 degrees) so that the ankle joint axis is parallel to the image receptor

Tube Head Position: 90 degrees from vertical

Central Ray: directed at the center of the ankle joint

Medial Oblique Ankle

Image Receptor: vertical in orthoposer

Foot Position: back of foot (heel) is placed against image receptor; the extremity is internally rotated 45 degrees

Tube Head Position: 90 degrees from vertical

Central Ray: directed at the center of the ankle joint

External Oblique Ankle

Image Receptor: vertical in orthoposer

Foot Position: back of foot (heel) is placed against image receptor; the extremity is externally rotated 45 degrees

Tube Head Position: 90 degrees from vertical

Central Ray: directed at the center of the ankle joint

Lateral Ankle

Image Receptor: vertical in orthoposer

Foot Position: medial aspect of foot is placed against image receptor (IR); then the heel is pulled away slightly from the IR so that the ankle joint axis is perpendicular to the IR

Tube Head Position: 90 degrees from vertical

Central Ray: directed at the fibular malleolus

References:

  1. Christman RA: Foot and Ankle Radiology, 2nd edition, Lippincott Williams & Wilkins, 2015.