Overview of Fluoroscopy Podiatric Assessment, Protocols, and Interpretation
Fluoroscopy is a technique that uses a special type of X-ray machine, known as a C-arm, to take live or still images of your foot. This might be done in a clinic or a hospital operating room. There are many reasons to use this procedure when looking at the foot, such as injecting into the foot for a diagnosis, testing the stability of the foot’s ligaments under stress, or checking the results of a surgery to correct a deformity in the foot during the operation.
Your foot is quite complex with a total of 30 joints and 26 bones. It can be challenging to locate specific areas just by looking at the surface of your foot. However, with fluoroscopy and proper positioning of your foot, doctors can clearly identify specific areas within your foot.
Anatomy and Physiology of Fluoroscopy Podiatric Assessment, Protocols, and Interpretation
When a doctor wants to see a picture of your foot, they will use something called X-ray radiography. The positions in which you place your foot and the angle at which the X-ray beam hits your foot will need to shift based on what exactly the doctor is trying to see. Initially, the doctor will take pictures using three different angles – straight from the front (anterior to posterior view), from the side (lateral view) and from a diagonal (oblique view).
For the first view, you will lay down flat (supine) on your back with your foot flat on the bed, and the X-ray beam will be angled downwards (caudal) by about 10 degrees. This allows the doctor to see specific parts of your foot including the joints connecting your inner foot and toes.
Next, to get the oblique image, your foot will stay in the same position but the beam will be angled 30 to 40 degrees to the side. This provides a better view of the middle and front parts of your foot. A lateral view (side view) can also be captured either by keeping the beam at a right angle to the side of your foot, or by you lying down with your foot propped up and the X-ray beam shining down from above. This view focuses on the middle of the foot at the base of the bones leading to your toes (metatarsals).
Special attention may be paid to the heel bone (calcaneus) if required. Capturing images from the side of the heel and from directly above can help the doctor see the joints more accurately. Capturing these views requires you to position yourself and your foot in very specific ways.
There are also some special views to see specific parts of your foot. For instance, the Broden view helps visualize the subtalar joint, which is a complex joint in your foot behind the ankle. The Canale view focuses on the talus bone’s neck and the front of the calcaneus. For the sesamoid view, the doctor looks at two specific small bones (sesamoids) under the base of your big toe. You will need to be in specific positions for these images to be captured accurately.
Besides bones, some soft tissues around the foot bones might not be visible in X-rays. One such structure is the plantar plate, which provides stability to the joint at the base of our toes (metatarsal phalangeal joint). If there is an injury to the plantar plate, the doctor may be able to see some signs of it in an X-ray image of the sesamoids.
Why do People Need Fluoroscopy Podiatric Assessment, Protocols, and Interpretation
It can be tough to diagnose an injury to the Lisfranc ligament, a band of tissue that connects the bones of the midfoot, especially if there’s no clear fracture. Doctors can use a procedure called a fluoroscopic stress exam to check for this type of injury. Indications for this exam could include pain in the middle of the foot after an injury, along with possible swelling or bruising on the underside of the foot. There should be no obvious widening between the first and second bones of the foot and no apparent fracture or displacement.
During surgery, doctors can use fluoroscopic imaging – a type of real-time x-ray – to assess if the correction of a condition known as hallux valgus, or bunions, is successful. Studies show that this method can accurately display the outcome of the correction procedure, allowing for adjustments to be made during surgery. After correcting hallux valgus, doctors need to examine the side view of the foot to ensure that the first bone of the foot is not pointing upward, as this could cause post-surgery pain and a condition known as metatarsalgia, which is pain in the ball of the foot.
Fluoroscopy can also be used to pinpoint the location of foot pain. This involves injecting a mix of local anesthetic and steroid into the area of suspected damage or where the pain is most intense. The clinical findings after the injection can confirm and document the precise locations of the injections. This method should be based on clinical history and physical examination to identify the suspected area where the injection will be administered. Targeted injections under fluoroscopic guidance are an easy procedure that can provide both pain relief and essential information for more effective treatment, such as deciding where a joint fusion surgery, or arthrodesis, should be conducted.
A plantar plate tear of the first MTP joint, also known as “turf toe” when it is caused by a sudden injury, is a condition that can be diagnosed using fluoroscopy. Patients with this condition can have stiffness, pain, swelling in the joint of their big toe, typically after a heavy load is placed on the joint while the toe is extended. A plantar plate injury can be treated without surgery if the tear isn’t complete, but if there is a full tear, it requires timely surgical repair. A doctor can use fluoroscopy to get a side view of the forefoot to diagnose a plantar plate tear.
When a Person Should Avoid Fluoroscopy Podiatric Assessment, Protocols, and Interpretation
There are particular instances when a doctor cannot carry out a fluoroscopic (a type of X-ray test) examination of the Lisfranc ligament, which is in the foot. This is typically when the ligament is clearly torn or there are fractures. If either of these situations is present, there’s no need for any further testing.
In the case of injections guided by fluoroscopy, a doctor should not perform the procedure if there are signs of a local infection. Signs might include an area of skin turning red, known as erythema, or a collection of pus, known as an abscess. These could result in the infection spreading to a joint. It’s also important to avoid this procedure if a patient is allergic to the steroid or local numbing medicine that will be injected.
Equipment used for Fluoroscopy Podiatric Assessment, Protocols, and Interpretation
For all the procedures mentioned before, a special X-ray machine known as a C-arm will be necessary. This device helps the doctor see precise locations inside your body during the operation. Sometimes, a sheet or a towel might be used to ensure you are in the correct position on the operating table.
For shots, you will need items that can keep the injection site clean and free from infection – these are called sterilization swabs or solutions. A small liquid holder, known as a 3-5 cc syringe, will be used to hold and administer the injection. The injection itself is given through a thin, pointed instrument called a 25 gauge needle. Lastly, the doctor will use a steroid and a local anesthetic – these are medicines. The steroid helps to reduce inflammation and the anesthetic helps to numb the area to reduce pain. The choice of specific steroid and anesthetic used depends on the doctor’s decision.
Who is needed to perform Fluoroscopy Podiatric Assessment, Protocols, and Interpretation?
Only the doctor carrying out the process is needed for this procedure. However, it can be more helpful to have an assistant around. They can give you clean tools, or help you with the machine used for an injection. All this can be done while making sure everything remains germ-free.
Preparing for Fluoroscopy Podiatric Assessment, Protocols, and Interpretation
For the doctor to clearly see and capture the necessary images during a medical scanning procedure (commonly known as fluoroscopy), they must arrange the unit, the patient, and the viewing screen appropriately. This correct setup helps avoid any unnecessary movements during the process, making the procedure smoother and safer for the patient.
How is Fluoroscopy Podiatric Assessment, Protocols, and Interpretation performed
When your doctor needs to do a guided injection, they may use a special X-ray technique called fluoroscopy. This helps to make sure the needle is put in the right place within your body. Usually, they use a very thin needle because the spaces in your joints are small.
The needle is first used on its own – it’s lined up with the joint where the injection will happen. This is done using the pictures from the X-ray. The doctor will then slowly guide the needle into the joint, still using the X-ray to watch what’s happening. The doctor will also use their touch – often, they can actually feel when the needle hits the bone, and then they can adjust the needle’s position. Injecting into small joints (like in your toes) can be very accurate because both the X-ray pictures and the doctor’s touch are used to guide the needle.
When the needle is in the right place, then the injection can happen. It’s easier to see the needle’s placement on the X-ray images if the needle is used alone (without the syringe attached) to begin with. Different joints in your body require different positions for the injection, and the X-ray images help guide this. More specifics on this are noted in the example. But whether it’s the toes or ankles, the doctor needs to be mindful of other structures around (like tendons and arteries) so the injection goes in the right place.
The X-ray also helps the doctor evaluate the health and function of certain parts of your feet. For example, assessing the ligament in your foot (called the Lisfranc ligament) or the small bones in your big toe (called sesamoids). An X-ray can be used to measure distances or movements (like how the sesamoids move when your toe moves). This gives important information about the health of your foot.
So, using fluoroscopy for guided injections is very helpful – the X-ray images help to ensure the needle goes in the right spot and gives valuable information about your foot’s health.
Possible Complications of Fluoroscopy Podiatric Assessment, Protocols, and Interpretation
In some medical procedures, like injections guided by fluoroscopy (a type of X-ray), there might be a few complications. These can include a risk of infection, or damage to parts of the body near where the injection is given. For certain injections, there are specific structures that need to be avoided to prevent damage.
For instance, when getting an injection in the joints of the fingers or toes (interphalangeal and metatarsophalangeal joints), it’s important to avoid the extensor tendons. These are the tissues that help you straighten your fingers and toes. If they get pricked too often, they could become weaker.
When an injection is given in the joints where the bones of the foot meet the toes (tarsometatarsal joints), great care needs to be taken to avoid the dorsalis pedis artery. This artery carries blood to the top of the foot, and it’s especially crucial to avoid during the first, second, and third TMT joint injections.
Similarly, when the facets of the subtalar joint (the joint in your ankle) are being approached for an injection, the doctor must take care not to damage the peroneal tendons. Peroneal tendons are the tissues on the side of your ankle that help stabilize the foot and protect it from injury. These can be damaged if they’re pricked with a needle.
What Else Should I Know About Fluoroscopy Podiatric Assessment, Protocols, and Interpretation?
Fluoroscopy is a type of medical imaging that shows a continuous X-ray image on a monitor, much like an X-ray movie. By using fluoroscopy, doctors can confirm and record the exact locations of injections in a patient’s body. In a study conducted by a researcher named Lucas and his team, patients were given injections in the foot and ankle guided by fluoroscopy. This method improved the confidence of the doctors in their diagnosis and helped them decide the next best steps for treatment.
In another research study, this technique was used to help find the sources of pain in patients before they underwent surgery. By clearly identifying the source of their discomfort, doctors were able to successfully perform a procedure known as arthrodesis (joint fusion surgery) in most cases.
Fluoroscopy is also handy for identifying a health issue known as plantar plate tear, a condition where the ligament in the ball of your foot is damaged. Identifying this condition is important because it usually requires immediate surgical repair to prevent complications like loss of ‘push-off’ strength needed for walking and a deformity known as ‘cock-up toe’, where the toe points upwards.