May 29th 2020

PLAIN X-RAY OF THE

ANKLE
Team : FM/TK
MOD : AK
SUPV : dr. Michael John Tedjajuwana, M.Kes, Sp.OT
Standard X-Ray views of Ankle

• Anteroposterior
• AP Oblique (Mortise View)
• Lateral
AP View
Radiologic Observations
• Lateral malleolus of fibula extends
below the medial malleolus
• Lateral malleolus is superimposed
behind the lateral aspect of the tibia
• Medial or lateral shift or
displacement of the talus within
the mortise may indicate the
presence of laxity, instability, or
fracture of the ankle.
• An abnormally wide joint space
between the distal tibia and fibula
indicates disruption of the distal
tibiofibular syndesmotic complex
AP View

Mc Kinnis, Lynn. Fundamentals of musculoskeletal imaging 4 thEd. 2014. F. A Davis company.

 AP Oblique (Mortise) view
Radiologic Observations
• The entire radiographic joint space of the
ankle proper the ankle mortise, is visible
• Mortise width is normally 3 to 4 mm over
the entire surface of the talus, an extra 2
mm in widening is considered normal
• Abnormal widening of one side of the
mortise or displacement of the talus
indicates the presence of ligamentous
laxity, injury, or fracture
• Abnormally wide space (>6mm) between
the distal tibia and fibula suggest
disruption of the distal tibiofibular
syndesmotic complex
Mc Kinnis, Lynn. Fundamentals of musculoskeletal imaging 4 thEd. 2014. F. A Davis company.
AP Oblique (Mortise) view

Mc Kinnis, Lynn. Fundamentals of musculoskeletal imaging 4 thEd. 2014. F. A Davis company.

AP Oblique (Mortise) view

Mc Kinnis, Lynn. Fundamentals of musculoskeletal imaging 4 thEd. 2014. F. A Davis company.

 Lateral View
Radiologic Observations
• The fibula is superimposed behind
the posterior tibia and talus
• The anterior tubercle and posterior
rim (Third malleolus/posterior
malleolus) of the tibia are well
demonstrated
• The subtalar joint is well
demonstated
• The talus and calcaneus are seen in
their entirely, as well as their
articulations with the navicular and
cuboid bones, respectively

Mc Kinnis, Lynn. Fundamentals of musculoskeletal imaging 4 thEd. 2014. F. A Davis company.

Lateral View

Mc Kinnis, Lynn. Fundamentals of musculoskeletal imaging 4 thEd. 2014. F. A Davis company.

 Lateral View

Mc Kinnis, Lynn. Fundamentals of musculoskeletal imaging 4 thEd. 2014. F. A Davis company.

Stress views of Ankle

Assess joint instability (ligament function)

• AP Inversion and Eversion Stress Views
• Anterior Talar Drawer Stress Views

Mc Kinnis, Lynn. Fundamentals of musculoskeletal imaging 4 thEd. 2014. F. A Davis company.

AP Inversion and Eversion Stress Views

• What can we observe?

• Joint Space
• Talar Tilt
Measure the angle formed by intersection
of line across tibial plafond and talar dome
Normal value
• Inversion (5-15°)
• Eversion (<10°)
Mc Kinnis, Lynn. Fundamentals of musculoskeletal imaging 4 thEd. 2014. F. A Davis company.
Anterior Talar Drawer Stress Views
• Anterior force applied on the
posterior aspect of the heel, resulting
in anterior transposition of the talus
from the tibia
• Measurement is taken from posterior
aspect of the tibia to the posterior
aspect of the talus. (separation 5-10
mm is considered as normal)
• >10 mm indicates disruption of the
anterior talofibular ligament

Mc Kinnis, Lynn. Fundamentals of musculoskeletal imaging 4 thEd. 2014. F. A Davis company.

= THANK YOU =
 May 29th 2020

PLAIN X-RAY OF THE

ANKLE
Team : FM/TK
MOD : AK
SUPV : dr. Michael John Tedjajuwana, M.Kes, Sp.OT