 Today’s post is going to be about positioning standing feet. This is a highly debated topic. I think this is also something that can be very site dependent as well as just focused, On different clinical, like if you are at a ortho location, they might have a specific view or something they want you to do versus if you were at a different hospital or clinic. This is my own personal experience, but also just some things to keep in mind and or to ask if you are not sure how to perform this type of an exam. So standing feet, why do we do them? We do standing feet to see the pressure of the foot. And how it responds to having the weight on it. So the key to this is you want a true weight-bearing foot.
This means you want the foot flat on the ground or the board the whole time. You want them standing, putting weight on it, ’cause that is the point of the views. Now, typically these follow the standard views that we do for a three view foot, such as a ap. And a like and a lateral. Now, every place that does standing feet has different helpful tools and contraptions to make this easier. Typically for a lateral, they will have a step that you put the board in and you can have them stand with the affected foot in front of it, the unaffected foot behind it this way. They’re able to stand with equal weight on both feet, still having that pressure on that foot. Typically then most places due to this, will be okay with you shooting a lateral to medial foot, lateral, not from a medial to lateral view.
Right. So you’re gonna have that inside of your foot up against the board versus the outside of the foot, against the board like we do when we do a supine foot. Now, the key to this is to make sure that they’re standing with equal weight on both feet, and that you have the board drop down low enough.
That you’re able to see underneath all of that tissue of the bottom of the foot, right? So you want that board to sink into whatever contraption it is, just a little bit. So it’s a little bit lower. ’cause if you have your foot standing and the board on the ground at the same level, you will cut off part of the anatomy.
Now, the real reason we wanted to bring this topic up is the AP and obl. So typically, most places have a board that you put the cassette underneath to protect it. That can be weight-bearing. You typically tell that patient to put their foot in the middle of the board that they can step on and you have them stand with equal weight on both feet. Or I like to tell them, put a little pressure on it. If they are like my foot, it hurts really bad, or following up a fracture, I will. Have them set it on there. I won’t make them put a ton of pressure on it. And right before eggs goes, I say, okay, put some weight on it. So you have that pressure of how the joints will react.
Now it also gets a little interesting because your tube most likely will be very close to the patient. So it is important to make sure you’re giving them as much room as possible, as comfortable as possible. I find most places are okay if you increase your SIDA tiny bit to give them that room if needed.
Now, the last one is the biggest reason. These are so debated. You’re a blank. Take a second. Think about how you ob, like when you do a supine foot, right? You first do your ap, their foot is sitted on the board, and then you have them turn their foot, so the outside of the foot by the pinky toe is turned up off of the board. Well, think about this. You can’t do that while you’re standing. That doesn’t work. Because you no longer are doing a true weight-bearing foot, you just took all of that weight off of the foot by having them OBL like that. So when they’re standing and you’re doing a weight-bearing foot, you want that foot flat on the board and instead of turning their foot up.
You are going to turn your tube and give it an angle, so that same angle you’re gonna turn that foot up on a supine foot exam is going to be the same amount of angle you’re gonna throw on your tube while you leave the foot flat on the board. That should project the same and give you that oly that you need while still giving a true weight-bearing foot. Yeah, mind blown, right? So it’s about 50 50 on sites and techs and students that do this or think about it in that term. However, if you are asked to do a weight-bearing foot, that is a true weight-bearing foot to do it that way. Now, some ortho places, some clinics, some provider might be like, Nope, that’s fine.
That’s not what I’m looking for, so do it the way they want. But if they’re looking for a true weight-bearing foot on that obl, you leave that foot AP on the board and you turn your tube. Now, how do you know that you have that OBL foot? Right? You’re gonna be looking at those metatarsals, making sure that they look how they should compared to the AP. But that digs a little bit more into image evaluation, which I will talk about later, but this post was just to bring up the highly debated weight-bearing. If you genuinely want a weight-bearing foot, make sure that the foot is flat with pressure on it throughout the whole exam.