Pediatric foot (medial oblique view)

The medial oblique foot view for pediatrics is one of three views performed to examine the phalanges, metatarsals and tarsal bones of the foot.

Indications

This projection is useful in diagnosing fractures; particularly 5^th metatarsal fractures, soft tissue effusions, joint space abnormalities and localizing foreign bodies in pediatric patients. 

Patient position

• the patient is supine with the affected knee flexed

• plantar aspect of the affected foot resting on the image receptor

• the foot is medially rotated until the plantar surface is at a 45° angle to the image receptor

Technical factors

• anteroposterior projection

• centering point

  • base of the 3^rd metatarsal

• collimation

  • lateral to the skin margins

  • anterior to the skin margins of the distal phalanges

  • posterior to the skin margins of the calcaneum

• orientation  

  • portrait

• detector size

  • 18 cm x 24 cm

• exposure ¹

  • 50-55 kVp

  • 1-2 mAs

• SID

  • 100 cm

• grid

  • no

Image technical evaluation

The patient's foot is adequately obliqued when the 5^th metatarsal is demonstrated as free from superimposition with no superimposition of the 3^rd to 5^th metatarsals. The bases of the 1^st and 2^nd metatarsals will demonstrate superimposition ². A physical metal marker is ideal for pediatric imaging. 

Practical points

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 foot is moved onto the detector. 

Immobilization techniques

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 ³