Calcaneus Projections

Patient Preparation

• Explain the procedure to the patient.
• Remove shoes, socks, and metallic objects from the foot and ankle region.
• Ensure patient comfort and correct positioning.
• Use lead shielding where applicable.

BASIC PROJECTIONS

1. Plantodorsal (Axial) Projection — Calcaneus

Positioning:

• Patient supine or seated with the leg fully extended.
• Ankle dorsiflexed so that the plantar surface of the foot is perpendicular to the image receptor (IR).
• Center the ankle joint to the midline of the IR.

Central Ray (CR):

• Directed 40° cephalad from the long axis of the foot (toward the heel).
• Enters at the base of the third metatarsal.

Collimation:

• Include the entire calcaneus from the tuberosity to the talocalcaneal joint.

Evaluation Criteria:

• Visualization of the calcaneus and subtalar (talocalcaneal) joint.
• No rotation — the first or fifth metatarsals should not project laterally.
• Adequate density and sharp detail of bony trabeculae.

2. Lateral (Mediolateral) Projection — Calcaneus

Positioning:

• Patient lies on affected side.
• Leg and foot in lateral position.
• Dorsiflex the foot to form a right angle (90°) with the lower leg.
• Center the calcaneus to the IR.

Central Ray (CR):

• Perpendicular to the IR.
• Directed 2.5 cm (1 inch) distal to the medial malleolus (enters midway between the malleoli).

Collimation:

• Include entire calcaneus, ankle joint, and base of fifth metatarsal.

Evaluation Criteria:

• Calcaneus in true lateral position.
• Open subtalar joint.
• Adequate visualization of the calcaneus, talus, and adjacent tarsal bones.
• Superimposed superior portions of the talar domes.

Image Evaluation Checklist

• Correct exposure and contrast for soft tissue and bony detail.
• No motion artifacts.
• Entire calcaneus included.
• Proper centering and anatomical markers visible.

Common Pathologies Demonstrated

• Calcaneal fractures.
• Bone spurs and heel pain evaluation.
• Subtalar joint abnormalities.
• Osteomyelitis and other bony lesions.