Foot and Ankle Radiology

by Christman

• ISBN13: 9780443087820
• ISBN10: 0443087822
• Edition: 1st
• Format: Hardcover
• Copyright: 2002-12-13
• Publisher: Churchill Livingstone

Summary

This text/atlas of radiography introduces the scope of diagnostic radiology applicable to podiatric medicine, including normal and pathological presentations of the foot and ankle. It covers the principles of radiographic interpretation, normal and variant radiographic anatomy and development of the foot and ankle, systematic evaluation of bone and joint disorders, as well as bone and joint abnormalities. An excellent guide to the radiographic presentations of pathologic conditions, this book acquaints the reader with specific radiologic pathology of the foot and ankle and offers a solid understanding of general diagnostic radiology and pathologic correlation. It also demonstrates how to systematically analyze a radiograph and identify conditions that are intrinsic to the foot or that represent manifestations of extrinsic disease. Approximately 1,000 quality radiographs and line drawings illustrate concepts and disorders. Normal and variant radiographic anatomy is discussed and illustrated, providing examples of both normal and variant radiographs for effective comparison. A specific section on bone and joint disorders presents specific examples of these types of disorders.

Table of Contents

SECTION 1 Plain Film Radiography
Radiation Physics, Biology, and Safety	3	(14)
The Physics of Diagnostic Imaging	3	(4)
Radiation and Matter	3	(2)
Production of X Rays	5	(1)
Interaction of X Rays With Matter	6	(1)
Biological Effects of Ionizing Radiation	7	(5)
Molecular Effects	7	(1)
Cellular Effects	8	(2)
Effects on Tissues	10	(1)
Whole-Body Effects	10	(1)
Radiation-Induced Risk of Cancer	11	(1)
Radiation Protection	12	(4)
Quantities and Units	13	(1)
Sources of Radiation: Natural and Man-Made	13	(1)
Regulatory Agencies and Standards for Radiation Protection	14	(1)
How to Protect Oneself From Radiation	14	(1)
Room Shielding	15	(1)
Principles of Radiation Protection: As Low As Reasonably Achievable (ALARA), Below Regulatory Concern (BRC) or DeMinimus, and Hormesis	15	(1)
Critique	16	(1)
Radiography Equipment Considerations and Accessories	17	(27)
Lower Extremity--Specific X-Ray Units	17	(7)
Tubehead	19	(1)
Beam Limitation Device	20	(2)
Arm	22	(1)
Control Panel	23	(1)
Selecting a Lower Extremity X-Ray Unit	23	(1)
X-Ray Equipment Quality Control	24	(1)
Extremity Fluoroscopy Equipment	24	(1)
Positioning Equipment and Aids	24	(4)
Orthoposer	24	(1)
Podium	25	(1)
Cassette Holder	26	(1)
Positioning Blocks	26	(1)
Sandbags	26	(1)
Axial Sesamoid-Positioning Device	27	(1)
Ankle-Specific Positioning Equipment	27	(1)
Technical Aids	28	(2)
Caliper	28	(1)
Compensation Filter	28	(2)
Lead Blocker	30	(1)
Technique Chart	30	(1)
Protection and Safety Aids	30	(1)
Radiation-Protective Clothing	30	(1)
Protective Barriers	31	(1)
Radiation Dosimetry Badges	31	(1)
Radiographic Film, Screens, and Cassettes	31	(2)
Radiographic Film	32	(1)
Intensifying Screens	32	(1)
Cassettes	33	(1)
Processing and Darkroom Equipment and Accessories	33	(5)
Safelight	33	(1)
Film Storage	33	(1)
Film Carry Case	34	(1)
Manual Processing Equipment	34	(1)
Automatic Film Processors	35	(1)
Silver Recovery System	36	(1)
Processing Quality Control	36	(1)
Polaroid Radiographic System	37	(1)
Film Identification and Storage	38	(2)
Film Identification Printer	38	(1)
Radiopaque Labeling Tape	38	(1)
Lead Character Marker Identification Sets	39	(1)
Right (R) and Left (L) Identification Markers	40	(1)
Film-Viewing Tools	40	(1)
Radiograph Illuminators	40	(1)
Magnifiers	41	(1)
Spotlight Illuminators	41	(1)
Film Labeling, Filing, and Duplication	41	(2)
Film Envelopes/Preservers	41	(1)
X-Ray File Cabinets	41	(1)
Filing System	41	(1)
Film Label Tape	42	(1)
Logbook	42	(1)
Radiographic Film Duplicators	42	(1)
References	43	(1)
Positioning Techniques and Terminology	44	(30)
Views, Projections, and Positions	44	(4)
The Predicament	44	(1)
The Solution	45	(1)
Application	46	(1)
Special Considerations	46	(1)
Overview of Positioning Techniques	47	(1)
General Considerations	48	(1)
Preparation for the Radiographic Study	48	(1)
Angle and Base of Gait Positioning	49	(1)
Foot-Positioning Techniques	50	(5)
Dorsoplantar Projections	50	(1)
Oblique Positions	50	(4)
Lateral Positions	54	(1)
Toe-Positioning Techniques	55	(2)
Dorsoplantar Projections	55	(1)
Oblique Positions	55	(1)
Lateral Positions	55	(2)
Sesamoid-Positioning Techniques	57	(2)
Posteroanterior Sesamoid Axial Projections	57	(2)
Anteroposterior Sesamoid Axial Projection (Holly Method)	59	(1)
Lateromedial Tangential Projection (Causton Method)	59	(1)
Tarsal-Positioning Techniques	59	(6)
Dorsoplantar Calcaneal Axial Projection	59	(1)
Plantodorsal Calcaneal Axial Projection	60	(1)
Harris-Beath Calcaneal Axial Projection	61	(1)
Broden Method	62	(1)
Isherwood Method	63	(2)
Ankle-Positioning Techniques	65	(7)
Anteroposterior Projections	65	(2)
Mortise Position	67	(1)
Oblique Positions	68	(2)
Lateral Positions	70	(2)
References	72	(1)
Suggested Readings	73	(1)
Exposure Techniques and Special Considerations	74	(22)
Radiographic Density	75	(5)
Kilovoltage	76	(1)
Distance	76	(1)
Film/Screen Combinations	77	(1)
Effects of Film Processing	78	(2)
Contrast	80	(1)
Detail	81	(2)
Geometry	81	(1)
Material (Films/Screens)	81	(1)
Film/Screen Contact	82	(1)
Motion	83	(1)
Distortion	83	(2)
Technique Guides	85	(2)
Fixed Kilovoltage	85	(1)
Variable Kilovoltage	86	(1)
Other Considerations	87	(4)
Children	87	(1)
Geriatrics	88	(1)
Pathological Considerations	88	(1)
Cast Radiography	89	(1)
Magnification	89	(2)
Soft Tissue	91	(1)
References	91	(2)
Appendix 1 Troubleshooting: Poor Film/Image Quality Checklist	93	(1)
Appendix 2 Formulas for Exposure Calculation	94	(2)
Film Quality	96	(27)
The History of X-Ray Film	96	(1)
The History of Intensifying Screens	97	(3)
Object of Radiography	100	(1)
Structure and Manufacture of X-Ray Film	100	(1)
Image Formation	101	(8)
Sensitometry	102	(3)
Film Processing/Development	105	(4)
Automated Processing	109	(1)
Quality Control	109	(2)
Darkroom	111	(3)
Special Considerations	111	(2)
Safelights	113	(1)
Viewing Equipment	114	(1)
Storage	114	(1)
Troubleshooting	114	(1)
Artifacts	114	(6)
Static	114	(1)
Fog	114	(4)
Stain	118	(1)
Scratches	118	(1)
Technical Error	118	(2)
References	120	(3)
SECTION 2 Radiographic Anatomy
Principles of Radiographic Interpretation	123	(7)
Viewing Tools	123	(1)
Viewbox	123	(1)
Magnifying Glass	123	(1)
Spotlight	123	(1)
Film Placement	124	(1)
Basic Concepts of Image Formation	124	(5)
References	129	(1)
The Normal Foot and Ankle	130	(12)
References	141	(1)
Normal Variants and Anomalies	142	(46)
Variants of Number	143	(2)
Partite Sesamoids at the First Metatarsophalangeal Joint	143	(1)
Bipartite Medial Cuneiform	144	(1)
Bipartite Navicular	144	(1)
Supernumerary Bones	144	(1)
Absence of Normally Existing Bones	145	(1)
Variants of Position	145	(3)
Forefoot	145	(1)
Midfoot	145	(1)
Tarsus and Ankle	145	(3)
Variants of Form	148	(16)
Distal Phalanx	148	(1)
Middle Phalanx	149	(1)
Proximal Phalanx	149	(2)
Sesamoids	151	(1)
Metatarsals	151	(1)
Cuneiforms, Cuboid, and Navicular	152	(2)
Talus	154	(2)
Calcaneus	156	(1)
Distal Tibia and Fibula	157	(1)
Synostosis/Coalition	157	(7)
Variants of Density	164	(2)
Radiolucencies	164	(2)
Increased Densities	166	(1)
Variants of Architecture	166	(3)
Cortical Bone	166	(3)
Cancellous Bone	169	(1)
Accessory Ossicles	169	(15)
Os Interphalangeus	170	(1)
Accessory Sesamoids	170	(1)
Os Intermetatarseum	170	(2)
Tibialis Anterior Tendon Sesamoid	172	(1)
Os Paracuneiforme (Os Cuneonaviculare Mediale)	172	(1)
Os Cuboid	172	(1)
Os Vesalianum	172	(1)
Persistent Fifth-Metatarsal Apophysis	172	(1)
Os Peroneum	173	(1)
Os Infranaviculare	173	(1)
Os Supranaviculare	173	(1)
Os Supratalare	173	(1)
Accessory Navicular (Os Tibiale Externum)	173	(4)
Os Calcaneus Secundarius	177	(1)
Os Sustentaculum Tali	177	(1)
Os Trochleare Calcanei	177	(1)
Os Subcalcis	178	(1)
Os Aponeurosis Plantaris	178	(1)
Os Trigonum	179	(2)
Os Supracalcaneum	181	(1)
Os Talotibiale	181	(1)
Os Subtibiale	181	(1)
Os Subfibulare	182	(2)
References	184	(1)
Suggested Readings	185	(3)
Normal Development	188	(14)
References	200	(1)
Suggested Readings	200	(2)
Developmental Variants	202	(23)
Multiple Ossification Centers	202	(3)
Pseudoepiphyses	205	(2)
Accessory Epiphyses	207	(1)
Absent Ossification Centers	208	(1)
Accessory Ossicles	208	(1)
Tarsal Coalition	209	(1)
Variants of Form	209	(11)
Phalanges	209	(1)
Metatarsals	210	(1)
Tarsal Bones	211	(9)
References	220	(1)
Suggested Readings	221	(4)
SECTION 3 Systematic Approach to Bone and Joint Abnormalities
View Selection for the Radiographic Study	225	(15)
Bilateral versus Unilateral Study	225	(1)
Number of Views	226	(1)
Overutilization	226	(1)
Technical Considerations	227	(1)
Selection of Positioning Techniques	228	(10)
Hallux	229	(1)
Lesser Digits	229	(1)
Sesamoids	229	(1)
First Metatarsal	230	(1)
Second Through Fourth Metatarsals	231	(1)
Fifth Metatarsal	232	(1)
Cuneiforms	233	(2)
Cuboid	235	(1)
Navicular	235	(1)
Talus	235	(1)
Calcaneus	235	(1)
Distal Tibia	235	(1)
Distal Fibula	235	(3)
References	238	(2)
Systematic Evaluation of Bone and Joint Abnormalities	240	(21)
Primary Features of Film Evaluation	241	(10)
Position	241	(1)
Form	242	(1)
Density	243	(3)
Architecture	246	(5)
Method of Assessment	251	(5)
General Overview	251	(1)
Soft Tissue Examination	251	(2)
Examination of Bone and Contiguous Structures	253	(1)
Joint Evaluation	253	(3)
Summary	256	(2)
References	258	(3)
SECTION 4 Radiographic Biomechanical Analysis
Principles of Biomechanical Radiographic Analysis of the Foot	261	(11)
Review	261	(1)
Terminology	262	(1)
Position	262	(1)
Stability	262	(1)
Alignment	262	(1)
Principles of Stability	262	(3)
Normal (Rectus) Foot Alignment Based on Principles of Stability	265	(2)
Foot Radiographs Do Not Have a Neutral Position for Reference	267	(2)
Summary	269	(1)
References	270	(2)
Foot Segmental Relationships and Bone Morphology	272	(31)
Dorsoplantar Radiographic Analysis	273	(14)
Longitudinal Axis of the Rearfoot	273	(1)
Longitudinal Axis of the Talar Neck and Head	273	(1)
Longitudinal Axis of the Lesser Tarsus	274	(1)
Longitudinal Axis of the Metatarsus (and Forefoot)	274	(1)
Longitudinal Axis of the Digits	275	(1)
Talocalcaneal Angle	275	(1)
The Lesser Tarsus Angle	275	(1)
The Metatarsus Adductus Angle	275	(1)
The Z Foot Situation	276	(1)
Forefoot Angulations	276	(1)
Proximal Articular Set Angle	276	(1)
Distal Articular Set Angle	277	(1)
Hallux Abductus Angle	277	(1)
Metatarsus Primus Adductus Angle	278	(1)
Sesamoid Position	279	(1)
First-Metatarsal Length	279	(2)
Hallux Limitus and Rigidus	281	(1)
Hallux Interphalangeal Angle (Hallux Abductus Interphalangeus)	281	(1)
The Digital Angle	282	(1)
Metatarsal Break and Curve	282	(1)
Relative Metatarsal Length and Height	283	(1)
Fifth-Metatarsal Relationships	284	(1)
Talar Superimposition on the Calcaneus (Talocalcaneal Superimposition)	284	(1)
Talonavicular Articulation and Wedge-Shaped Navicular	285	(1)
Accessory Navicular	286	(1)
Calcaneocuboid Angle	286	(1)
Talocuboid Angle	286	(1)
Other Dorsoplantar Radiographic Signs	287	(1)
Lateral Radiographic Analysis	287	(9)
The Calcaneal Inclination Line and Angle	287	(1)
Haglund's Deformity	288	(1)
Calcaneal Spurring	289	(1)
Boehler's Angle	290	(1)
Talar Declination Line and Angle	290	(1)
Dorsiflexed Talus: Pseudoequinus	290	(1)
Talar Trochlear Surface Shape	290	(1)
Talar Neck Dorsal Exostosis	290	(1)
Talar Head Shape	291	(1)
Lateral Talocalcaneal Angle	291	(1)
Subtalar: Sustentaculum Tali Changes	291	(1)
Subtalar: Sinus Tarsi and Posterior Articular Facet Alignment	291	(1)
Signs of Restricted Subtalar Joint Range of Motion	292	(1)
The Cyma Lines	292	(1)
The Foot-Arch Formula	292	(1)
The Talonavicular, Naviculocuneiform, and Calcaneocuboid Faults	292	(1)
Cuboid Declination (Plantarflexed Cuboid)	293	(1)
Fifth Metatarsal	293	(1)
Wedge-Shaped Navicular	293	(1)
Naviculocuboid Superimposition	293	(1)
Congenital Versus Acquired Arch Deformities	294	(1)
First Ray	294	(1)
First-Metatarsophalangeal Joint	294	(1)
Hallux	295	(1)
Digital Contractures	296	(1)
Radiographic Analysis Using Other Views	296	(2)
Lateral-Stress View of the Ankle	296	(1)
Sesamoid Axial View	296	(1)
Anterior Axial Projection of the Foot	297	(1)
Limb Length Inequality	298	(1)
Correlation of Foot Radiographic Signs to Foot Morphology	298	(1)
Acknowledgments	299	(1)
References	299	(4)
Pediatric Abnormalities of Position	303	(14)
Axes and Angular Relationships	304	(3)
Axes: Dorsoplantar View	304	(1)
Axes: Lateral View	304	(1)
Angles: Dorsoplantar (Anteroposterior) View	305	(1)
Angles: Lateral View	306	(1)
Special Radiographic Views	307	(1)
Subtalar Neutral Views	307	(1)
Forced Plantarflexion Lateral View	308	(1)
Forced Dorsiflexion Lateral View	308	(1)
Congenital Abnormalities and Anomalies	308	(6)
Calcaneovalgus	308	(1)
Congenital Pes Valgus	309	(1)
Accessory Navicular	310	(1)
Metatarsus Adductus	311	(1)
Tibial Torsion	312	(1)
Talipes Equinovarus	312	(2)
References	314	(1)
Suggested Readings	314	(3)
SECTION 5 Special Imaging Procedures
Overview of Special Imaging Studies	317	(27)
Stress Studies	317	(3)
Inversion and Eversion Stress Studies	318	(1)
Anterior Stress Study	319	(1)
Contrast Studies	320	(4)
Arthrography	320	(1)
Tenography	321	(1)
Sinography	321	(1)
Bursography	322	(1)
Gangliography	322	(1)
Angiography	322	(2)
Nuclear Medicine Studies	324	(4)
Technetium	326	(1)
Gallium and Indium	327	(1)
Cross-Sectional Imaging Studies	328	(5)
Conventional Tomography	329	(1)
Computed Tomography	329	(3)
Magnetic Resonance Imaging	332	(1)
Miscellaneous Studies	333	(6)
Magnification Radiography	333	(4)
Ultrasonography	337	(1)
Xeroradiography	338	(1)
Fluoroscopy	338	(1)
Low-Kilovoltage Radiography	339	(1)
References	339	(4)
Suggested Readings	343	(1)
MRI/Cross-Sectional Imaging	344	(55)
Diagnostic Techniques and Cross-sectional Anatomy	344	(11)
Conventional Tomography	344	(11)
Computed Tomography	355	(1)
Magnetic Resonance Imaging	355	(1)
Trauma	355	(10)
Ligamentous Injuries	355	(2)
Tendonous Injuries	357	(3)
Fractures	360	(5)
Nonunions	365	(1)
Bone Bruises	365	(1)
Foreign Bodies	365	(1)
Plantar Fascial Diseases	365	(2)
Plantar Fasciitis and Heel Pain Syndrome	365	(1)
Plantar Fascial Tears and Ruptures	366	(1)
Plantar Fibromatosis	366	(1)
Infection	367	(3)
Cellulitis and Soft Tissue Abscess	367	(1)
Osteomyelitis	368	(1)
Deep Plantar Space Infection	369	(1)
Articular Disorders	370	(2)
Degenerative Joint Disease	370	(1)
Vacuum Joint Phenomenon	370	(1)
Inflammatory Arthritis	371	(1)
Metabolic Deposition Disease	371	(1)
Neuropathic Arthropathy	372	(1)
Neoplasm	372	(10)
Skeletal Neoplasms	372	(5)
Soft Tissue Neoplasms	377	(4)
Metastatic Disease	381	(1)
Congenital Anomalies	382	(1)
Tarsal Coalition	382	(1)
Other Congenital Anomalies	383	(1)
Neural Impingement Syndrome	383	(1)
Tarsal Tunnel Syndrome	383	(1)
Marrow Space Disorders	384	(2)
Ischemic Necrosis	384	(1)
Reflex Sympathetic Dystrophy	385	(1)
Collagen Disorders	386	(1)
Marfan's Syndrome	386	(1)
Ehlers-Danlos Syndrome	387	(1)
References	387	(12)
SECTION 6 Bone and Joint Disorders
Fractures and Related Conditions: Fundamentals	399	(16)
Diagnosis	399	(1)
Fracture Terminology	399	(3)
Dislocation and Subluxation	402	(1)
Biomechanics	403	(5)
Direction and Anatomy of Fracture	408	(2)
Fracture Healing	410	(4)
References	414	(1)
Classification of Fractures and Dislocations	415	(37)
Digital and Metatarsal Fractures and Dislocations	415	(1)
First Metatarsophalangeal Joint Fractures-Dislocations	415	(1)
Fifth-Metatarsal Fractures	416	(3)
Lisfranc Fracture and Dislocations	419	(4)
Midtarsal Joint Fracture-Dislocations	423	(1)
Navicular Fractures	423	(2)
Transchondral Fractures of the Talar Dome	425	(2)
Talar Fractures and Dislocations	427	(2)
Fracture of the Posterior Process of the Talus	429	(1)
Calcaneal Fractures	430	(2)
Epiphyseal Fractures	432	(7)
Early Study of Ankle Fractures	439	(1)
Pott's Fracture	439	(1)
Dupuytren's Fracture	439	(1)
Maisonneuve Fracture	439	(1)
Chaput-Tillaux Fracture	439	(1)
Wagstaffe Fracture	439	(1)
Von Volkmann Fracture	439	(1)
LeFort Fracture	440	(1)
Cotton Fracture	440	(1)
Ankle Fractures and Dislocations	440	(9)
References	449	(2)
Suggested Readings	451	(1)
Osteonecrosis and Osteochondrosis	452	(14)
Osteonecrosis	452	(5)
Osteochondrosis	457	(7)
Osteochondritis Dissecans	464	(1)
References	465	(1)
Bone Infection	466	(16)
Definition of Terms	466	(6)
Classification of Osteomyelitis	472	(3)
Diabetic Osteomyelitis versus Osteolysis	475	(1)
Common Organisms Causing Bone Infection	476	(2)
Special Imaging Modalities	478	(2)
References	480	(1)
Suggested Readings	481	(1)
Joint Disease	482	(26)
Systematic Approach to Differentiating Joint Disorders	482	(15)
Roentgen Features at Involved Joints: Primary Findings	484	(6)
Roentgen Features at Involved Joints: Secondary Findings	490	(4)
Roentgen Features at Sites Distant from Involved Joints	494	(2)
Patterns of Joint Disease and Distribution of Roentgen Findings	496	(1)
Characteristic (and Uncharacteristic) Presentations	497	(10)
Osteoarthritis	497	(3)
Rheumatoid Arthritis	500	(2)
Psoriatic Arthritis	502	(1)
Gouty Arthritis	503	(2)
Neuropathic Osteoarthropathy	505	(2)
References	507	(1)
Bone Tumors and Tumorlike Lesions	508	(40)
Systematic Evaluation of Solitary Bone Lesions	508	(8)
Destructive Pattern	508	(2)
Size and Shape	510	(1)
Cortical Involvement	511	(1)
Periosteal Reaction	511	(1)
Anatomic Position	511	(1)
Skeletal Location	512	(1)
Trabeculation	512	(1)
Matrix Production	513	(3)
Clinical Course	516	(1)
Age of Patient	516	(1)
Overview of Pedal Involvement	516	(2)
Malignant Bone Tumors	518	(2)
Osteogenic Sarcoma (OS)	518	(1)
Chondrosarcoma	519	(1)
Ewing Sarcoma	519	(1)
Benign Bone Tumors	520	(17)
Nonossifying Fibroma (Nonosteogenic Fibroma, or NOF) and Fibrous Cortical Defects (FCD)	520	(1)
Solitary Osteochondroma (Osteocartilaginous Exostosis)	521	(2)
Bizarre Osteochondromatous Proliferation (Nora's Lesion)	523	(1)
Simple Bone Cyst (Unicameral or Solitary Bone Cyst)	524	(1)
Aneurysmal Bone Cyst (ABC)	524	(2)
Giant Cell Tumor of Bone (GCT, Osteoclastoma)	526	(1)
Enchondroma	526	(3)
Chondromyxoid Fibroma (CMF)	529	(1)
Juxtacortical (Periosteal) Chondroma	529	(1)
Chondroblastoma	530	(1)
Osteoid Osteoma	531	(2)
Enostosis (Solitary ``Bone Island'')	533	(4)
References	537	(1)
Suggested Readings	538	(10)
Miscellaneous Disorders	548	(1)
Osteoporosis	548	(2)
Osteomalacia and Rickets	550	(2)
Hyperparathyroidism	552	(1)
Renal Osteodystrophy	553	(1)
Acromegaly	553	(2)
Hypovitaminosis C (Scurvy)	555	(2)
Paget's Disease (Osteitis Deformans)	557	(1)
Hereditary Multiple Exostoses (Osteochondromatosis)	557	(1)
Osteogenesis Imperfecta	557	(1)
The Sclerosing Dysplasias	558	(3)
Fibrous Dysplasia	561	(1)
Soft Tissue Manifestations of Systemic Disorders	561	(1)
Calcification	561	(7)
Ossification	568	(3)
References	570