Toes (oblique view)

Last revised by Andrew Murphy on 23 Mar 2023

The toes medial oblique view is part of the toe series examining the phalanges and metatarsals of the foot.

This view shows the region of interest with 45° medial obliquity. It serves as another angle to evaluate any joint abnormalities such as gout (especially in the first digit) and osteoarthritis, in addition to determining fractures or dislocations of all phalanges of a specified toe(s).

  • the patient may be supine or upright depending on comfort
  • the affected leg must be flexed enough that the plantar aspect of the foot is resting on the image receptor
  • the foot is medially rotated until the plantar surface sits at a 45° angle to the image receptor
  • AP oblique projection
  • centering point
    • x-ray beam centered to the metatarsophalangeal joint in question
    • the beam will be perpendicular to the image receptor 
  • collimation
    • lateral to the skin margins
    • anterior to the skin margins of the distal phalanges
    • posterior to at least the distal half of the metacarpal(s)
  • orientation  
    • portrait
  • detector size
    • 18 cm x 24 cm
  • exposure
    • 50-55 kVp
    • 3-4 mAs
  • SID
    • 100 cm
  • grid
    • no
  • superimposition is evident at the bases of the of 1st and 2nd metatarsals 
  • there is no superimposition of the 3rd to 5th metatarsal

The metatarsal and tarsal bones are the most reliable rotation indicator:

  • if the foot is over-rotated, the base of the 5th metatarsal will be superimposed by the tubercle of the 4th metatarsal
  • if the foot is under-rotated the bases of the 4th and 5th metatarsals will overlap; the image may have a closer resemblance to a DP projection of the foot

It is always good to label what toe you are imaging to avoid any confusion.

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