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Fluoroscopy of the foot is vital to the evaluation, diagnosis, and treatment of patients with foot and ankle pathology. There are patient positioning methods and techniques that provide the health care professional with more precise images that assist in diagnosis and treatment. Understanding these techniques and positioning tips can help locate an accurate location and treat the area of injury with an injection or other indicated treatment option. This activity reviews fluoroscopic imaging of the foot and explains how the interprofessional team can use fluoroscopic evaluation to treat patients with foot and ankle pathology. Objectives: Outline indications, technique, and identification of Lisfranc ligament injury using fluoroscopy. Identify anatomic structures at risk with injections of the foot. Describe how to perform basic imaging of the foot. Explain how to perform the fluoroscopic evaluation of the subtalar joint by an interprofessional team. Access free multiple choice questions on this topic.

Fluoroscopy is using the C-arm to get live or static images of the foot. This can be used in the clinic or in the operating room. There are multiple reasons to use fluoroscopy procedures in the assessment of the foot. Diagnostic injections into the multiple joints of the foot, stress examinations to evaluate for ligamentous instability, and intra-operative evaluation of deformity correction are all examples of reasons to use fluoroscopy. The anatomy of the foot involves 30 joints and 26 bones that can be difficult to identify from surface landmarks alone. Using fluoroscopy and positioning the foot correctly, you can accurately identify your location.

There are few complications, most being with procedures such as fluoroscopic guided injections. Infection is a risk as well as damage to nearby anatomic structures. There are specific structures with each type of injection to be avoided. For injection of the interphalangeal and metatarsophalangeal joints, the extensor tendons need to be avoided as they could become weakened with multiple needle sticks. When injecting the tarsometatarsal joints, one must avoid the dorsalis pedis artery with the first, second, and third TMT joint injections. The posterior, middle, and anterior subtalar joint facets are approached from lateral, and the clinician must avoid the peroneal tendons as they can be damaged from needle sticks.[12]

Podiatric fluoroscopy is a useful tool for the identification of injuries and diagnostic or treatment injections. Communication with the patient on the positioning is important, and it is beneficial to have an assistant to help during injections. Healthcare team outcomes are enhanced with good interprofessional communication between nurses, clinicians (including mid-level practitioners), and X-ray technicians. These teams must coordinate to limit radiation exposure and obtain proper imaging. Using fluoroscopy in the clinic as well as intraoperatively has shown to help with clinical diagnosis and prediction of postoperative alignment. When done properly with a coordinated team, fluoroscopic radiographs have been shown to have high reliability.[8] [Level 2]

Health Professionals such as X-ray techs should maintain their equipment to ensure accuracy and safety.  All members of the interprofessional team should maintain a safe environment by keeping the furthest distance from the radiation source and limiting the exposure time to all team members.

Proper monitoring by both the X-ray tech and surgeon should be done to ensure limited radiation exposure.  All team members should be monitored to make sure they have proper protective lead aprons and thyroid shields and maintain the furthest distance possible from the radiation source.