Pediatric ankle (mortise view)

Last revised by Andrew Murphy on 23 Mar 2023

The mortise ankle view for pediatrics is one of three views to examine the distal tibia, distal fibula, proximal talus and proximal fifth metatarsal. Depending on the child's age and the departmental protocol, the mortise view may or may not be performed.

Mortise and mortice are variant spellings and equally valid 1.

This projection demonstrates the mortise joint, particularly the lateral border of the mortise. It is useful for diagnosing fractures; particularly distal fibular fractures, joint space abnormalities and localizing foreign bodies in pediatric patients.

  • the patient is supine with their affected foot in slight dorsiflexion

  • leg is rotated internally 15° to 20° to align the 5th toe with the center of the calcaneum

  • anteroposterior projection

  • centering point

    • the midpoint of the lateral and medial malleoli

  • collimation

    • laterally to the skin margins

    • superior to examine the distal third of the tibia and fibula

    • inferior to the proximal aspect of the metatarsals

  • orientation

    • portrait

  • detector size

    • 18 x 24 cm

  • exposure 2

    • 50-55 kVp

    • 1-2 mAs

  • SID

    • 100 cm

  • grid

    • no

The entire mortise joint should be open with only slight superimposition of the distal tibiofibular joint 3. A physical metal marker is ideal for pediatric imaging. 

Preparing the room beforehand (setting up the detector, exposure and preparing lead gowns) is important as pediatric patients may not remain still when their affected ankle is moved onto the detector. 

It is important for the radiograph to be free from motion artifact and rotation to avoid repeated x-rays.

  • it may be necessary for the parent or radiographer to hold the patient in position

  • ideally the parent should be in the child's direct line of sight

  • techniques will vary based on the department

  • distraction techniques can be utilized to avoid scattered radiation to parents and staff 4

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