LITTLE ROCK — Although pedorthists only need to perform a physical examination to be able to diagnose a patient’s foot problems, being able to read an X-ray can help clinicians understand how severe the problem is and help prescribe the right orthosis, according to a lecture presented at the Pedorthic Footcare Association’s Annual Symposium.

“It would be helpful to pedorthists if X-rays were available to be able to understand what they are looking at with regard to mechanical challenges that changes in the skeletal structure bring to the foot,” James McGuire, PM, CPed, associate professor at Temple University’s School of Podiatric Medicine and director of the Leonard Abrams Center for Advanced Wound Healing, told O&P Business News. “You are not way behind if you can’t take an X-ray. As a pedorthist you are not diagnosing problems, but I think it gives a great understanding of the foot so you can better understand the degree of support that you are going to have to provide with an orthotic, brace or shoe.”

How x-rays can help

McGuire’s lecture was a basic overview of X-ray quality, how to read an X-ray, the characteristics of a good X-ray, basic X-ray anatomy and the basic angle assessment of a patient’s X-ray. By paying attention to the density, contrast, detail and image fidelity of the X-ray, clinicians can determine if the X-ray image can be used for diagnosis.

In general, McGuire said X-rays can be improved by longer exposure time, higher miliamperage and kilovoltage, shorter tube to cassette distance and proper processing. Image fidelity can also be improved if the foot is in contact with the cassette or film holder with optimal tube to foot distance and a well aligned incident beam and no motion. However, the quality will decrease if there is motion or a poorly aligned incident beam.

Using X-rays to determine the severity of the injury can help in choosing the right orthosis or shoe and improve the use of some of the more sophisticated orthoses that provide a little more support than intended for the patient’s shoe. And in a patient with arthritis, an X-ray could also alter a clinician’s recommendation for shoes.


James McGuire



“The evaluation of angles helps to determine not only the presence of a deformity, but its severity,” he said. “All of this information aids the clinician in choosing an appropriate treatment regimen.”

Additional education

McGuire said pedorthists would benefit from learning about basic X-ray pathology and how it affects biomechanics. Additional education could include a basic short course or lecture in pedorthic education on reading X-rays, particularly from a mechanical standpoint, and “understanding basic pathology and how it affects biomechanics and then how to apply using X-rays to make the decisions on shoes and orthoses,” McGuire said. “It will be helpful to the pedorthic community to be able to review X-rays and make intelligent suggestions to the physicians about what to do, what types of bracing to use and what types of orthosis/shoe combinations would be helpful for the condition they are looking at.” — by Casey Murphy

For more information:
McGuire J. Radiology of the foot and ankle: what pedorthists need to know. Presented at: Pedorthic Footcare Association Annual Symposium; Nov. 1-3, 2012; Little Rock, Ark.

Disclosure: McGuire has done research for Drexel, TEI Biosciences Inc., Integra LifeSciences and Diapedia Insole and is a consultant for Devon Medical Co. and NeoMedics Inc.

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