Ankle AP Mortise

Overview

The AP mortise ankle radiograph visualizes the ankle joint with the mortise open by internally rotating the foot approximately 15 degrees. This projection displays the tibial plafond talar dome and fibular relationship. It is standard for ankle trauma and arthritis evaluation.

Technique

Internally rotate the foot to align the malleoli parallel to the detector and center to the ankle joint. Ensure the entire mortise is included and use appropriate exposure. Immobilize the limb to reduce motion artifact.

Clinical Indications

AP mortise is indicated for trauma suspected fracture and evaluation of joint congruity. It helps detect talar dome lesions and syndesmotic widening. Additional lateral and oblique views complement the mortise projection.

Image Assessment

Assess joint space symmetry and inspect for cortical disruption of the malleoli and talus. Evaluate for talar tilt and syndesmotic injury. Document findings and recommend orthopedic consultation when indicated.

Ankle Lateral

Overview

The lateral ankle radiograph profiles the talus calcaneus and distal tibia to assess alignment and fractures. The foot is positioned in true lateral with the medial and lateral malleoli superimposed. This view is essential for trauma and preoperative planning.

Technique

Position the ankle in true lateral and center the detector to include the distal tibia and calcaneus. Use appropriate exposure and immobilize the limb to minimize motion. Include the subtalar joint when indicated.

Clinical Indications

Lateral ankle is indicated for trauma suspected fracture and evaluation of hindfoot alignment. It complements AP mortise and oblique views for comprehensive assessment. CT is used for complex fractures and surgical planning.

Image Assessment

Evaluate talar dome integrity calcaneal alignment and posterior malleolar involvement. Inspect for joint effusion and soft tissue swelling. Report findings relevant to orthopedic management and fixation planning.

Ankle Mortise Stress

Overview

Ankle stress radiographs apply controlled force to evaluate syndesmotic and lateral ligament stability. They are performed under fluoroscopic guidance or with manual stress during radiography. Stress views help determine need for surgical stabilization.

Technique

Apply inversion eversion or external rotation stress while obtaining AP mortise or specialized stress projections. Use protective measures and informed consent due to discomfort risk. Document the applied stress and technique used.

Clinical Indications

Stress views are indicated for suspected ligamentous injury when standard views are inconclusive. They assess widening of the mortise and talar tilt. MRI may be used to directly visualize ligament tears when needed.

Image Assessment

Measure joint space widening and talar tilt compared with the contralateral side. Evaluate for associated fractures and instability patterns. Report findings to guide orthopedic decision making.