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X-ray heels in two projections
Last reviewed: 23.04.2024
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The most accessible, informative and painless methods of visualization of bone structures is radiography. The picture also shows damage to the joints, cartilage traumatic and inflammatory genesis, and birth defects. X-ray of the heels gives an accurate idea of the presence or absence of injury after injury, helps to determine the cause of discomfort in this area of the limb.
This procedure is resorted to not only by surgeons, traumatologists and orthopedists, but also by rheumatologists and endocrinologists to confirm connective tissue lesions, oncologists - if a tumor of this localization is suspected.
Indications for the procedure
- Suspicions of post-traumatic injuries of bone, articular, cartilage tissue in the heel area.
- Complaints of the patient on the discomfort of this localization, lameness, gait disturbances with suspected inflammatory processes (arthritis, bursitis, synovitis, osteomyelitis), degenerative changes (arthrosis, gout, heel spur), congenital defects (flat foot, club foot, valgus deformity), and congenital defects (flat foot, club foot, valgus deformity). Osteo-articular tissue.
- With deep purulent abscesses of the back of the foot to prevent the spread of infection to the bone tissue.
- Monitoring the results of treatment.
Technique of the x-ray heels
Heel X-rays can be made in different positions of the foot, the choice of which is carried out by the doctor, based on the need to visualize it in a certain perspective.
The axial projection of the calcaneus is performed most frequently. Usually the patient lies on a table with straightened legs, a tape cassette is placed under the back surface of the heel of the sore foot, and the foot is bent in the direction of the shin as possible, sometimes by means of a bandage, which is kept by the patient. The central beam of x-rays is directed to the calcaneal tubercle along approximately the median of the right angle with the surface of the table.
You can take a picture in axial projection in a standing position. The patient becomes the foot of the sore foot on the cassette with the film, assuming a position in which her shin is bent over the floor at an angle of approximately 45 °, putting the second leg back. The position of the body is fixed by resting on a nearby object, for example, a substituted chair. An X-ray beam is directed to the heel knoll at an angle of 20 ° to the vertical axis.
To take a picture in the lateral projection of the patient is laid on its side from the side of the studied limb. Under her heel enclose the cassette, vertically direct the flow of x-rays and take a picture. At the same time, the second leg is bent slightly backward, removing it from the zone of translucence.
Laying options can be many, depending on the capabilities of the equipment and the required shooting angle, for example, in a straight line - you can lie on your back, bend your knees and rest your feet on the table, or the patient lies on the stomach, with the heel of the patient's leg up, and from below it at the level of the ankle joint enclose the roller.
X-ray diagnostics for arthritis to determine the degree of destruction of the joint is carried out under load - the patient stands on the sore leg. If necessary, sometimes it is done to compare x-rays of the heel of the second (healthy) leg.
X-rays of a child’s heel are made only when it is necessary to visualize, as, indeed, an adult. The technique is similar. The most difficult in this procedure is to ensure immobility. Young children are taken to the x-ray room with their parents, who soothe the baby, support and provide the necessary position and stiffness of the limb. Vital zones of parents and children during the procedure are protected with lead aprons.
Contraindications to the procedure
During a single X-ray procedure of heels, the radiation dose on any equipment does not exceed 0.01 mSv. There are no absolute contraindications for x-ray diagnostics of the calcaneus. Relative are pregnancy and childhood, when X-rays are done only in case of emergency.
It is not recommended to carry out the procedure in patients with severe bleeding and in critical conditions (shock, coma).
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Normal performance
On the radiograph, you can see the internal structure of the calcaneus, cartilage, articular joints, analyze the shape and interposition, determine the existing violations - fractures, dislocations, degenerative and inflammatory changes.
X-rays of healthy heels show whole, smooth and dense parts of the calcaneus - body and bump, with clear contours without roughness and patterns. X-ray of the heel in the normal state does not contain blackouts, displacement of the articular surfaces and the growth of bone tissue (osteophytes, tumors), due to which the heel bone contour becomes irregular. Cartilaginous pads have a normal thickness, the bones are not deformed.
X-ray: signs of disease
With complaints of pain in the heel, radiation diagnosis is required. Pain may not be associated with injury, however, always indicate trouble. Radiography is the most widely available and informative method, giving an idea of the state of bone tissue.
A common cause of pain is plantar fasciitis or heel spur. Acute wedge-shaped growths declares itself to be intense painful sensations that occur when a person comes on the heel, by hyperemia and the appearance of a hard light spot on the skin.
The spur on the heel on the radiograph in the lateral projection is perfectly visible, since this is a bone formation. It looks like a wedge or claw-shaped growth on the lower surface of the calcaneal tuber, usually closer to its center. The size of the growth is usually small, because with a spur more than 5 mm high the patient can no longer walk because of severe pain. Although there are osteophytes and 20 mm. X-rays can often tell the cause of the growth. Most often it is flatfoot, the appearance of a spur can also be triggered by trauma or a tumor.
After injury, an x-ray is prescribed so as not to miss a fracture of the heel. When it is detected, the localization of damage and the degree of complexity are determined.
A fresh injury is accompanied by severe pain and swelling in the heel area. X-rays are made in two projections, fracture lines look like dark uneven lines on white bones. The contours of the bones can persist (fracture without displacement - crack) or move relative to each other. There is also a comminuted fracture, when the bone splits into several small pieces. All of these types can usually be seen well on an x-ray.
There are cases when the fracture is not visible in the picture, however, the symptoms suggest its presence. Then, on the radiograph made in the projection from the side, the Beler angle is determined. Hold two straight. One of them is carried out through the upper points of the back calcaneus and the subtalar joint. The other is through the upper points of the subtalar joint and the frontal process of the calcaneus. The acute angle is measured at the intersection of these lines. If its value is less than 20 °, then a fracture is assumed, for which confirmation it is recommended to perform an additional computed tomography.
The heel bone of a child may "break", held by the whole periosteum. Such a fracture has the shape of a twig.
Osteoporosis - rarefaction, a decrease in bone density visually appears in the image as an unevenness or roughness of the bone, a change in its color, and the appearance of a pattern, since decalcified bones transmit x-rays that illuminate the film.
Tumors of bones, cartilage tissue and mixed look on the radiograph as additional formations with indistinct contours.
Complications after the procedure
If the recommended rules are followed, then there are no undesirable consequences after the procedure, which may be associated with radiation exposure.
If there is a need to perform x-rays of the heels for pregnant women, then the stomach is carefully covered with an apron with lead plates.
Persons who are in shock, pre-comatose, and comatose are sensitive to even minimal doses, so even after injuries or accidents, x-rays are taken only when the patient's condition stabilizes.
The same applies to patients with heavy bleeding. Complication after X-ray procedure can be a violation of blood flow, therefore, until the state stabilizes, no diagnosis is made.
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Reviews
Feedback on x-rays is positive. Radiography is quite informative, widely available, painless, does not require special training. Compared with computed tomography much cheaper, in addition, the dose of X-ray exposure is ten times less. However, additional volumetric diagnostics are sometimes required.