Clinical exam
- Weightbearing: To check for potential reducibility as the foot transitions from neutral to relaxed stance position.
- Non-weightbearing range of motion exam: A stable talotarsal mechanism will have little triplane motion. Tested by loading the 4th and 5th metatarsal heads and moving the foot from a pronated to supinated position and back.
- Gait analysis: Looking for evidence that could include “too many toes” sign, a prolonged period of pronation, calcaneal valgus and/or abductory twist.
- Partial talotarsal dislocation can be seen in Lateral and AP weightbearing views.
- It is important to take both as the deformity can have planal dominance.
- If the deformity is flexible, neutral stance position x-rays should show normal radiographic measurements.
- AP View
- Lateral View
- Talar declination angle
- Talocalcaneal angle“Open” sinus tarsi
- Sustentaculum tali slightly dorsiflexed
- Normal cyma line
- Normal navicular height
- In relaxed stance, will see at least one of the following:
- AP view:
- Talar 2nd metatarsal angle >16 degrees
- Bisection of the talus medial to the medial aspect of the 1st metatarsal
- Lateral view
- Talus anteriorly displaced on the cyma line
- Sustentaculum tali slightly plantarflexed
- Loss of navicular height/navicular drop
- Talar declination angle >21 degrees
- Talocalcaneal angle >46 degrees
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