Documentation of Toe X-Ray
When documenting a toe x-ray, include the clinical indication, specific views obtained (typically anteroposterior, lateral, and oblique), technical quality assessment, detailed findings of osseous structures and soft tissues, comparison to prior imaging if available, and a clear impression with recommendations for follow-up or additional imaging if needed.
Essential Clinical Information
- Document the clinical indication for the study, including mechanism of injury if trauma-related, location of pain or tenderness, and whether the patient can bear weight 1
- Record relevant history such as prior ulceration, amputation, neuropathy, peripheral vascular disease, or underlying bone disease, as these represent exclusionary criteria that affect clinical decision-making 1
- Note if Ottawa rules were applied and whether they were positive or negative, though recognize that toe trauma is not directly addressed by the Ottawa rules 1
Technical Documentation
- Specify the views obtained, as standard toe radiographs typically include anteroposterior, lateral, and oblique projections 1
- Document technical adequacy including whether the images are weight-bearing or non-weight-bearing, patient positioning, and image quality 2
- Note any limitations such as patient motion, inability to obtain certain views due to pain, or suboptimal positioning that may affect interpretation 3
Radiographic Findings to Document
- Osseous structures: Describe alignment, cortical integrity, trabecular pattern, and presence or absence of fracture 4, 5
- Fracture characteristics if present: Location (proximal, middle, or distal phalanx; intra-articular vs extra-articular), displacement, angulation, comminution, and involvement of the interphalangeal or metatarsophalangeal joints 1, 5
- Soft tissue assessment: Document swelling, soft tissue masses, foreign bodies, or gas in soft tissues 1, 4
- Joint spaces: Evaluate for narrowing, widening, subluxation, or dislocation 4, 5
- Bone quality: Note any evidence of osteopenia, underlying bone disease, or degenerative changes 5
Comparison and Impression
- Compare to prior studies when available to assess for interval changes, healing, or progression 2
- Provide a clear impression that directly answers the clinical question, such as "fracture present" or "no acute fracture identified" 1
- Include recommendations for additional imaging (CT or MRI) if the radiographs are equivocal or if there is clinical concern for occult fracture despite negative radiographs 1
Special Considerations
- High-risk patients: For patients with diabetes, neuropathy, or peripheral vascular disease, explicitly document these conditions as they significantly impact management and healing potential 1
- Pediatric considerations: In children, document growth plate appearance and any developmental abnormalities 6
- Follow-up recommendations: Specify timing for repeat imaging if indicated, particularly for suspected occult fractures or to assess healing 7