Plain Radiographic Evaluation of the Pediatric Foot and Its Deformities

Accurate diagnosis and assessment of severity of pediatric foot deformities by physical examination can be challenging. Radiographs are a valuable adjunct for accurate diagnosis and effective treatment for many of these deformities. On the standing anteroposterior view useful measurements include the talocalcaneal and talus-first metatarsal angles; on the standing lateral view various measurements include the talocalcaneal, tibiocalcaneal, tibiotalar, talus-first metatarsal, and talohorizontal angles. Additionally, the talocalcaneal, tibiocalcaneal, and talus-first metatarsal angles in maximum dorsiflexion or plantar flexion illustrate dynamic characteristics of the pediatric foot. Standard radiographic techniques are necessary for accuracy and reproducibility of these angles. Thus, the importance of positioning the patient properly and focusing the x-ray beam on the area of interest is discussed. Radiographic evaluation of several pediatric foot deformities which include metatarsus adductus, skewfoot, clubfoot, vertical and oblique talus, and tarsal coalition is presented.