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Extended Pedal Imaging via Modifications of the Traditional Forefoot Axial Radiographic Study

Teaching New Tricks to an Old Dog? An Initial Report with Case Presentations

Lawrence S. Osher Department of Radiology, Ohio College of Podiatric Medicine, Cleveland, OH.

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Matthew DeMore III Department of Surgery, Ohio College of Podiatric Medicine, Cleveland, OH.

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Said Atway Department of Orthopaedics and Podiatry, Ohio State University Medical Center, Columbus, OH.

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Matthew K. Thomson Detroit Medical Center, Detroit, MI.

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Background: The plain film forefoot axial radiographic view is a specialized view in podiatric imaging. In everyday office practice, an axial orthoposer is used, and the study is nonweightbearing. Largely useless for imaging functional pathology, the forefoot axial view’s main use centers around imaging of the plantar metatarsal heads and the hallucal sesamoid complex. To this end, the name “forefoot” is somewhat of a misnomer, and the view is also known as the sesamoid axial study.

Methods: We report on the initial use of oblique sesamoid or “skyline” axial studies for juxtacortical lesions of the sesamoid bones and more proximal dorsolateral tarsal structures, an area traditionally difficult to assess accurately with plain film imaging.

Results: Rather simple, empiric modifications in the forefoot axial technique allowed for 1) “skyline” imaging of exostotic surface lesions involving the dorsal, medial, and lateral midfoot bones, and 2) significant improvement in imaging hallucal sesamoid pathology.

Conclusions: Although the proposed oblique forefoot axial modifications empirically add two additional plain film radiographic studies to a standard forefoot axial study, our initial study suggests that the imaging benefits far outweigh the liabilities. This is especially true when one considers the difficulties encountered when employing standard plain film pedal in an effort to clarify or delineate pathologic processes involving the midfoot bones or metatarsal bases. It is hoped that this study will spawn further use and research of these “novel” views. (J Am Podiatr Med Assoc 98(3): 171–188, 2008)

Corresponding author: Lawrence S. Osher, DPM, Department of Radiology, Ohio College of Podiatric Medicine, Cleveland, OH 44106. (E-mail: losher@aol.com)