Toes and sesamoids

Patient and part

The patient sits or lies on the table with the knee flexed and the sole of the foot flat on the IR. The routine toe series is an AP, an oblique and a lateral. For the oblique, rotate the leg and foot 30 to 45 degrees medially. A medial oblique shows the 1st through 3rd toes best; a lateral oblique can show the 4th and 5th toes better. For the lateral, tape or loop gauze around the other toes and pull them out of the way. Put the affected toe closest to the IR: medial side down for the 1st through 3rd toes, lateral side down for the 4th and 5th. For the sesamoids under the head of the first metatarsal, the Lewis method has the patient prone with the toes dorsiflexed against the IR, and the Holly method has the patient seated with the toes pulled back with a strip of gauze.