Neutral and Relaxed Stance X-ray Positioning for TaloTarsal Joint Dislocation

Guide to: Neutral and Relaxed Stance Position Radiographs of the TaloTarsal Joint

The best way to diagnose TaloTarsal Dislocation

is via radiographic examination.

• How flexible/reducible is this partial talotarsal dislocation deformity?

• You can’t tell with this static relaxed position radiograph.

• That’s why there is a need to take comparison views.

Radiographic Comparison

• Provides objective data (can draw angles to compare normal versus abnormal accepted angular measurements)

• Excellent educational tool to show the patient their hindfoot deformity

• Documents the flexibility of the deformity • Rules out secondary pathologies

Can you pick which view is relaxed stance or neutral position?

Relaxed Stance Position Neutral Stance Position

If you are going to recommend an EOTTS-HyProCure procedure

it is very important to show radiographic evidence that the dislocation deformity is flexible.

Also, this will help to rule-out the possibility of a tarsal coalition.

Foot PositioningRelaxed StanceNeutral Stance

Relaxed Stance

That’s the easy position – patient just stands how they normally stand.

Neutral Position

This is where the TaloTarsal Joint should naturally be positioned during stance:

neither supinated nor pronated.

Normal TaloTarsal Joint Alignment

• The talus should be balanced on the calcaneus and navicular.

• Sinus tarsi is “open”• TTJ articular facets are

in Constant Congruent Contact

Foot PositioningNeutral Stance Position

The bisection of the leg (black line)

should line up with the bisection

of the 2nd metatarsal (green line).

Foot PositioningSupinated-Overcorrected Position

The juncture of the 2 lines bends outward/laterally.

This indicates a supinated hindfoot.

It is better to place the foot in a more supinated verse a more pronated position. The goal is to show that the talus can resupinate on the calcaneus.

Sign of TaloTarsal Dislocation

There is an inner/medial bend of the bisection of the leg and 2nd metatarsal.

“Pronated” position of the hindfoot.

Only a very “slight” amount of pronation is acceptable.

Technique:Take AP and Lateral Views

Can also take posterior calcaneal view and AP of the ankle – optional.

Lateral X-ray ImagingRelaxed Stance Position

• Tube is angle 90 degrees.

Lateral X-ray ImagingNeutral Stance Position

• The patient’s hindfoot is repositioned so that it is neither supinated nor pronated.

• The talus is repositioned the talus back on top of the calcaneus.

Dare to CompareRelaxed Stance Position Neutral Stance Position

Please make sure your x-ray technicianunderstands the difference

Relaxed Stance Position Neutral Stance Position

AP/DP X-ray ImagingRelaxed Stance Position

• Tube head is 15 degrees aimed at the mid-foot.

• Patient is standing on the x-ray plate.

AP/DP X-ray ImagingRelaxed Stance Position

At first glance you may not identify that this patient has a partial talotarsal dislocation.

AP/DP X-ray ImagingRelaxed Stance Position

At first glance you may not identify that this patient has a partial talotarsal dislocation.

However, on closer examination:there is a medial bend to the bisection lines.

AP/DP X-ray ImagingNeutral Stance Position

The x-ray will show a normal talotarsal joint alignment.

Make sure there is no “inner” bend to the junction of the bisection of the leg and 2nd metatarsal bone.

See the difference?

Relaxed Stance Position

Neutral Stance Position

Good Luck!

There is another module for the interpretation of these views.

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