neutral and relaxed stance x-ray positioning for talotarsal joint dislocation
DESCRIPTION
This module explains the radiographic positioning of the hindfoot to assist in the diagnosis of talotarsal dislocation.TRANSCRIPT
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Guide to: Neutral and Relaxed Stance Position Radiographs of the TaloTarsal Joint
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The best way to diagnose TaloTarsal Dislocation
is via radiographic examination.
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• How flexible/reducible is this partial talotarsal dislocation deformity?
• You can’t tell with this static relaxed position radiograph.
• That’s why there is a need to take comparison views.
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Radiographic Comparison
• Provides objective data (can draw angles to compare normal versus abnormal accepted angular measurements)
• Excellent educational tool to show the patient their hindfoot deformity
• Documents the flexibility of the deformity • Rules out secondary pathologies
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Can you pick which view is relaxed stance or neutral position?
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Relaxed Stance Position Neutral Stance Position
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If you are going to recommend an EOTTS-HyProCure procedure
it is very important to show radiographic evidence that the dislocation deformity is flexible.
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Also, this will help to rule-out the possibility of a tarsal coalition.
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Foot PositioningRelaxed StanceNeutral Stance
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Relaxed Stance
That’s the easy position – patient just stands how they normally stand.
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Neutral Position
This is where the TaloTarsal Joint should naturally be positioned during stance:
neither supinated nor pronated.
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Normal TaloTarsal Joint Alignment
• The talus should be balanced on the calcaneus and navicular.
• Sinus tarsi is “open”• TTJ articular facets are
in Constant Congruent Contact
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Foot PositioningNeutral Stance Position
The bisection of the leg (black line)
should line up with the bisection
of the 2nd metatarsal (green line).
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Foot PositioningSupinated-Overcorrected Position
The juncture of the 2 lines bends outward/laterally.
This indicates a supinated hindfoot.
It is better to place the foot in a more supinated verse a more pronated position. The goal is to show that the talus can resupinate on the calcaneus.
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Sign of TaloTarsal Dislocation
There is an inner/medial bend of the bisection of the leg and 2nd metatarsal.
“Pronated” position of the hindfoot.
Only a very “slight” amount of pronation is acceptable.
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Technique:Take AP and Lateral Views
Can also take posterior calcaneal view and AP of the ankle – optional.
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Lateral X-ray ImagingRelaxed Stance Position
• Tube is angle 90 degrees.
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Lateral X-ray ImagingNeutral Stance Position
• The patient’s hindfoot is repositioned so that it is neither supinated nor pronated.
• The talus is repositioned the talus back on top of the calcaneus.
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Dare to CompareRelaxed Stance Position Neutral Stance Position
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Please make sure your x-ray technicianunderstands the difference
Relaxed Stance Position Neutral Stance Position
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AP/DP X-ray ImagingRelaxed Stance Position
• Tube head is 15 degrees aimed at the mid-foot.
• Patient is standing on the x-ray plate.
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AP/DP X-ray ImagingRelaxed Stance Position
At first glance you may not identify that this patient has a partial talotarsal dislocation.
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AP/DP X-ray ImagingRelaxed Stance Position
At first glance you may not identify that this patient has a partial talotarsal dislocation.
However, on closer examination:there is a medial bend to the bisection lines.
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AP/DP X-ray ImagingNeutral Stance Position
The x-ray will show a normal talotarsal joint alignment.
Make sure there is no “inner” bend to the junction of the bisection of the leg and 2nd metatarsal bone.
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See the difference?
Relaxed Stance Position
Neutral Stance Position
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Good Luck!
There is another module for the interpretation of these views.
www.HyProCureDoctors.com