title: Extended pedal imaging via modifications of the traditional forefoot axial radiographic study: teaching new tricks to an old dog? an initial report with case presentations.
abstract: BACKGROUND
  The plain film forefoot axial radiographic view is a specialized view in podiatric imaging. In everyday office practice, an axial orthoposer is used, and the study is nonweightbearing. Largely useless for imaging functional pathology, the forefoot axial view's main use centers around imaging of the plantar metatarsal heads and the hallucal sesamoid complex. To this end, the name "forefoot" is somewhat of a misnomer, and the view is also known as the sesamoid axial study.
  
  
  METHODS
  We report on the initial use of oblique sesamoid or "skyline" axial studies for juxtacortical lesions of the sesamoid bones and more proximal dorsolateral tarsal structures, an area traditionally difficult to assess accurately with plain film imaging.
  
  
  RESULTS
  Rather simple, empiric modifications in the forefoot axial technique allowed for 1) "skyline" imaging of exostotic surface lesions involving the dorsal, medial, and lateral midfoot bones, and 2) significant improvement in imaging hallucal sesamoid pathology.
  
  
  CONCLUSIONS
  Although the proposed oblique forefoot axial modifications empirically add two additional plain film radiographic studies to a standard forefoot axial study, our initial study suggests that the imaging benefits far outweigh the liabilities. This is especially true when one considers the difficulties encountered when employing standard plain film pedal in an effort to clarify or delineate pathologic processes involving the midfoot bones or metatarsal bases. It is hoped that this study will spawn further use and research of these "novel" views.
authors.affiliation: Department of Radiology, Ohio College of Podiatric Medicine, Cleveland, OH 44106, USA. losher@aol.com
authors.forename: Lawrence S
authors.initials: LS
authors.lastname: Osher
authors.forename: Matthew
authors.initials: M
authors.lastname: DeMore
authors.forename: Said
authors.initials: S
authors.lastname: Atway
authors.forename: Matthew K
authors.initials: MK
authors.lastname: Thomson
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005529:Foot Bones / Q000000981:diagnostic imaging*; D005545:Forefoot, Human / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography