Foot X-ray: Lateral Projection

Sunday, September 16, 2012


Pathology Demonstrated:
  • Location and degree of anterior or posterior displacement of fracture fragments, joint abnormalities, soft tissue effusion, and locations of opaque foreign bodies are demonstrated.

Technical Factors:
  • IR size - 18 x 14 cm (8 x 10 inches) -  smaller foot, or 24 x 30 cm (10 x 12 inches) - large foot
  • Detail screen, tabletop
  • 60 +- 5 kV range
  • mAs 4

  • Place lead shield over pelvic area to shield gonads.

Patient Position:

  • Take radiograph with patient in lateral recumbent position; provide pillow for head.

foot xray laterals
Mediolateral foot
Part Position ( Mediolateral)
  • Flex knee of  affected limb about 45 degree; place opposite leg behind the injured limb to prevent overrotation of affected leg.
  • Carefully dorsiflex the foot if possible to assist in positioning for a true lateral foot and ankle.
  • Place support under leg and knee as needed so that plantar surface is perpendicular to IR. Do not overrotate foot.
  • Align long axis of foot to long axis of foot to long axis of IR (unless diagonal placement is needed to include entire foot).
  • Center mid area of base of metatasals to CR.

Central Ray:

  • CR perpendicular to IR, directed to medial cunieform (at level of base of third metatasals)
  • Minimum SID of 40 inches (100cm)


  • Collimate to the outer skin margins of the foot to include about 1inch [2 to 3 cm] proximal to ankle joint.

CR or DR:
  • Close collimation and lead masking are important over unused portions of image plate to prevent fogging from scatter radiation to the hypersensitive image plate or receptor.

Alternative lateromedial projection:

  • A lateromedial projection may be taken as an alternate lateral. This can be more uncomfortable or painful for the patient, but it may be easier to achieve a true lateral in this position.

Radiographic Criteria:

Structure Shown:

  • Entire foot should be demonstrated with a minimum of 1inch of 2.5 cm of distal tibiafibula.
  • Metatasals will be nearly superimposed with only the tuberosity of the fifth matatasal seen in profile.
foot xray laterals


  • The long axis of the foot should be aligned to the long axis of IR.
  • True lateral position is achieved when the tibiotalar joint is open, the distal fibula is superimposed by the posterior tibia, and the distal metatarsals are seperimposed.

Collimation and CR:

  • All soft tissue structure from phalanges to calcaneus should be included in the center of the four-sided collimated field with the center (CR) to the medial cunieform region.

Exposure Criteria:

  • Optimal density and contrast should visualize borders of superimposed tarsals and metatasals.
  • No motion; cortical margins and trabecular markings of calcaneus and nonsuperimposed portion of other tarsals should appear sharply defined.

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