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Normal Foot X-Ray Report Template (3-View)
Normal foot radiograph report template: AP, oblique and lateral views, alignment, forefoot, midfoot with the Lisfranc relationship, hindfoot, joint spaces and soft tissues, with notes on Lisfranc injury, the base of the fifth metatarsal and weight-bearing wording.
EXAMINATION: [Right / Left] foot radiograph, 3 views. CLINICAL HISTORY: [indication, e.g. “Twisting injury to the right foot, midfoot pain and swelling” / “Fall, forefoot pain, unable to bear weight”] COMPARISON: None available. TECHNIQUE: AP, medial oblique and lateral views of the [right / left] foot [, weight-bearing]. FINDINGS: Alignment: Normal alignment of the forefoot, midfoot and hindfoot. The medial border of the second metatarsal base aligns with the medial border of the middle cuneiform on the AP view, and the medial border of the fourth metatarsal base aligns with the medial border of the cuboid on the oblique view. No widening of the first-second intermetatarsal interval. Normal talar-first metatarsal (Meary's) angle on the lateral view. Forefoot: The metatarsals and phalanges are intact. No fracture of the base of the fifth metatarsal. No dislocation or subluxation of the metatarsophalangeal or interphalangeal joints. No hallux valgus. Midfoot: The navicular, cuboid and cuneiforms are intact. No fracture or diastasis at the Lisfranc (tarsometatarsal) joints. Hindfoot: The visualized talus and calcaneus are intact. Normal Bohler's angle on the lateral view. Normal calcaneal pitch. Joint spaces: Preserved without erosion, sclerosis or osteophyte. Mineralization: Normal. Soft tissues: No soft tissue swelling, radiopaque foreign body or soft tissue gas. [Mild dorsal soft tissue swelling.] Normal plantar fat pad. Accessory ossicles: [None. / Os peroneum / os naviculare / os trigonum, incidental.] IMPRESSION: 1. No acute fracture or dislocation of the [right / left] foot. 2. [Soft tissue swelling over the dorsal midfoot without underlying fracture.]
Dictation notes
- Two alignments clear the Lisfranc joint: second metatarsal base to the middle cuneiform on the AP, fourth metatarsal base to the cuboid on the oblique; a 2 mm or wider first-second intermetatarsal gap or a “fleck sign” at the base of the second metatarsal is a Lisfranc injury and gets weight-bearing views or CT.
- Non-weight-bearing films miss about a fifth of subtle Lisfranc injuries; say whether the study was weight-bearing and, when the history fits and the films are negative, recommend weight-bearing comparison views or CT rather than clearing the foot.
- Classify a fifth metatarsal base fracture by zone — tuberosity avulsion, Jones fracture at the metaphyseal-diaphyseal junction, or proximal diaphyseal stress fracture — because the Jones fracture has the nonunion risk and may be managed operatively.
- Accessory ossicles (os peroneum, os naviculare, os trigonum, os vesalianum) are named so they are not mistaken for fractures: a well-corticated rounded ossicle in a known location is normal; an irregular, non-corticated fragment is a fracture.
- Check the calcaneus and the ankle mortise on the lateral view even on a “foot” film: Bohler's angle under 20 degrees is a depressed calcaneal fracture, and the base of the fifth and the anterior process of the calcaneus are the classic edge-of-film misses.
Related references
Weber ankle fracture quick reference
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