Toes (oblique view)

The toes medial oblique view is part of the toe series examining the phalanges and metatarsals of the foot.

Indications

This view shows the region of interest with 45° medial obliquity. It serves as another angle to evaluate any joint abnormalities such as gout (especially in the first digit) and osteoarthritis, in addition to determining fractures or dislocations of all phalanges of a specified toe(s).

Patient position

• the patient may be supine or upright depending on comfort
• the affected leg must be flexed enough that the plantar aspect of the foot is resting on the image receptor
• the foot is medially rotated until the plantar surface sits at a 45° angle to the image receptor

Technical factors 

• AP oblique projection
• centering point
  • x-ray beam centered to the metatarsophalangeal joint in question
  • the beam will be perpendicular to the image receptor 
• collimation
  • lateral to the skin margins
  • anterior to the skin margins of the distal phalanges
  • posterior to at least the distal half of the metacarpal(s)
• orientation  
  • portrait
• detector size
  • 18 cm x 24 cm
• exposure
  • 50-55 kVp
  • 3-4 mAs
• SID
  • 100 cm
• grid
  • no

Image technical evaluation

• superimposition is evident at the bases of the of 1^st and 2^nd metatarsals 
• there is no superimposition of the 3^rd to 5^th metatarsal

Practical points

The metatarsal and tarsal bones are the most reliable rotation indicator:

• if the foot is over-rotated, the base of the 5^th metatarsal will be superimposed by the tubercle of the 4^th metatarsal
• if the foot is under-rotated the bases of the 4^th and 5^th metatarsals will overlap; the image may have a closer resemblance to a DP projection of the foot

It is always good to label what toe you are imaging to avoid any confusion.