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X-ray of the ankle
Last reviewed: 17.10.2021
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The most widely used non-invasive diagnostic method for detecting congenital and acquired pathological changes in bone and joint tissues is the visualization of their anatomy with the help of X-rays. Defects that appear in the structure of the skeleton of the foot and / or ankle, allows to identify the x-ray of the ankle, as destructured and healthy tissues differently absorb the X-rays passing through them, which is reflected in the projection image of this part of the body.
Indications for the procedure
It is prescribed as part of a diagnostic study for patients with ankle joint injuries with suspicion of fractures and dislocations, and also with complaints of pain and other uncomfortable sensations of the localization that may indicate inflammatory, dystrophic and oncological pathologies.
Patients with established lesions of the joint and / or bone tissue of the ankle are screened for monitoring the effectiveness of the treatment.
Technique of the ankle x-ray
A little anatomy: the joint that connects the bones of the shin and the foot, has a rather complex structure - the cartilage and muscle system connects three bones: the large and small bones of the shank and the tibial bone of the foot.
Clinical signs of ankle injury very much resemble the symptoms that arise when destructive changes of the Tar-heel and talon-navicular joint, as well as of the heel and calcaneus. Therefore, the radiographs are performed in two or three projections so that these anatomical structures can be considered well.
A straight rear projection provides a good overview of the node of the epigastric bone and part of the tibia; rear - with a turn of the foot inward allows you to consider the intercostal syndrome (joint); lateral - back of the tibia, large and small.
To implement the study in the lateral projection, the patient is placed on the table in the supine position on the side of the affected limb, its pr and eject slightly flexed in the hip and knee joint. A healthy limb is as tight as possible to the breast, so as not to interfere with the review.
To implement the radiography in a direct rear projection, the patient is laid on his back, bending the unbroken leg in the knee joint and pulling it to the body. The foot of the patient has a heel above the cassette at a right angle to the table, the exit opening of the X-ray apparatus is directed to the ankle joint.
To monitor the condition of the intercostal joint in the same position, the patient turns the foot inward, the angle of rotation is about 30 degrees. So that the foot does not fall down, under it lay a pillow.
Normal performance
This diagnostic method helps to identify various injuries of the ankle and bone tissue of the ankle:
- trauma - closed and open fractures of bones of the given localization, including cracks, complete and incomplete displacements of bone in the joint (dislocations, subluxations);
- inflammatory processes - arthritis, osteomyelitis, synovitis, bursitis;
- degenerative changes, bone and articular tissue deformations caused by metabolic disorders - gout, arthrosis, arthropathy;
- other congenital and acquired constitutional disorders of the joint elements.
Description of ankle x-ray
An x-ray doctor describes the visible structural changes in the joint structure of the shin and foot bones, making a diagnostic conclusion. As a standard, the norm of the ankle is used on x-rays.
For regular proportions of the structural elements of the ankle, the uniform height of the articular cleft is characteristic - a straight line that can be drawn through the center of the separated rounding of the tibia, as a rule, it must cross the center of the node of the coelomatum (between its elevations). The subluxation of the ankle on the x-ray usually looks like a wedge-like shape of the joint space. True, this anatomical feature in rare cases is also a variant of the norm, then the analogous structure of this element should be on both extremities.
The criterion for the correct location of the patient's leg in a direct rear projection is the distant parts of the tibia, the supraclavicular bone and the x-ray joint gap, whose appearance resembles the letter "G".
On the straight posterior projection, the capillary is not completely displayed. Clearly visible is its node, which should look like an irregular quadrilateral with well-visible upper and lateral sides. The upper side of the capillary is horizontally located, slightly bend in the middle, the medial and lateral elevations are visible, as well as the groove that separates them. The plate that closes the joint surfaces of this joint must be clear and thin.
In this projection, the lateral process is clearly visible. The outline of the plate should go smoothly into its contour, covered with articular cartilaginous tissue, which increases the area of the ankle's surface of the block. Its structure is spongy. All this leads to the fact that the fractures of the posterior (lateral) process are intrasensitive.
For a more thorough study of the lateral section of the anatomical gap of the ankle, a picture is considered with the turn of the foot inward. On it, a slit can be seen along its entire length as a curved ribbon-like enlightenment, the shape of which resembles the letter "P".
On the same image, it is possible to consider an intercleral syndesmosis more clearly, its width in norm should be from four to five millimeters. Maximum permissible fluctuations of this indicator are from two to nine millimeters. The width of soft tissues distributed along the lateral and medial surfaces should be uniform, and their volume is small.
The rear part of the far rounded end (epiphysis) of the tibia, which in surgery is often called the third (posterior) ankle, is one of the most likely localizations of the fracture, often combined with violations of the integrity of the medial and / or lateral ankles.
Five to six millimeters upward above the tip of the contour line of the medial malleolus, against the background of spongy formation, a horizontal line is visible-the outline of the excavation of its rear part. The medial site of the distal meta- and diaphysis of the tibia is layered in this form on the lateral portion of the far meta- and epiphysis of the tibia. This is an area of increased load intensity, on which fractures are frequent enough - violations of the integrity of the bone, which can easily be seen in the picture even to the layman. Fresh injuries in the form of cracks and bone impressions are usually poorly visualized, they are better visualized a few days after the injury.
A specific sign of dislocations is the displacement of bones, and an increase in the distance between the surfaces of the bones is for stretching and ligament injuries.
Osteoporosis, which develops due to calcium deficiency, is noticeable due to the increased dilatation (transparency) of the bone in the center and thickening of the osseous borders.
Osteomyelitis of the ankle on the x-ray can be detected about a week after the onset of the disease. In the initial stages, the septa between the muscles and fascia are not visually differentiated, clearly visible in the picture of a healthy person. Also, the border separating the muscle structure and subcutaneous tissue is not noticeable, the saturation and volume of soft tissues increase. Key signs of the disease are osteonecrosis - death of bone tissue of bone, sequestration - rejection of necrotic areas.
Arthrosis of the ankle on x-ray looks like a modification of the thickness of the cartilaginous layer and the gap between the bone structures, as well as changes in the configuration of the closure plates. The joint gap is unevenly narrowed and deformed. There is a noticeable growth of bone tissue along the edge of the joints - osteophytes, thickening of bone tissue at the border with the cartilaginous. Also on the radiographs can clearly see calcification of ligaments.
Arthritis on the roentgenogram is characterized by an expansion of the joint gap - the effects of inflammatory effusion in the joint cavity.
Tumors of the bone, joint and soft tissues are visualized as formations without a clear contour that extend beyond the normal structure. Characteristic are the destructive changes surrounding the neoplasm.
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Complications after the procedure
The procedure is non-invasive and absolutely not traumatic, without consequences if certain rules are observed, in particular, do not do x-rays more than once every six months. The permissible radiation load on the body should not exceed 5 mSv. Sv is a sievert, the amount of energy absorbed by the body upon irradiation. With different types of radiography, it is different. More modern equipment does less damage to the patient's body.
The main complication after the procedure is the excess of the allowable exposure threshold.
Constant contraindications for examination are severe mental illnesses, which become an obstacle to the implementation of safety rules and the presence of metal prostheses in the area under examination.
Temporary are pregnancy (X-rays to future mothers are done only in case of emergency, covering the belly with a lead apron) and a serious condition of the patient who needs reanimation measures.
The patient can be assigned other types of diagnostics for additional diagnostics (ultrasound, MRI, CT), which allows further clarification of the diagnosis.