Toes AP Oblique is a radiography positioning projection of the Lower Extremity. Foot rotated medially 45 degrees, CR perpendicular. SID 40". The centering point is located 3rd metatarsophalangeal (mtp) joint, with foot rotated medially 30-45 degrees.. The central ray is perpendicular to the mid-foot in 45-degree oblique.. Image-quality criteria include all five toes visible and in 45-degree oblique projection., foot rotated enough to open the lateral joint spaces.. Standard exposure ranges from 55 to 65 kVp, 2 to 4 mAs, at an SID of 40 inches (102 cm).
Anatomy demonstrated
- All five toes in oblique projection.
- Lateral aspects of the first and second toes.
- Metatarsophalangeal joint spaces partially open.
- Metatarsal shafts and bases.
- First through fifth metatarsal heads.
Patient preparation
- Verify patient identity using two identifiers.
- Remove footwear, socks, and any radiopaque foot jewelry.
- Position the patient supine or seated with the leg extended.
- Place the affected foot flat on the IR.
- Rotate the foot medially (inward) to achieve 45-degree oblique position.
Position & centering point
3rd metatarsophalangeal (MTP) joint, with foot rotated medially 30-45 degrees.
Central ray
Perpendicular to the mid-foot in 45-degree oblique.
Exposure / technique
- kVp
- 55–65
- mAs
- 2–4
- SID
- 40" (102 cm)
- Notes
- Rotate the foot inward (medially) to achieve 45-degree oblique position.
Image-quality criteria
- All five toes visible and in 45-degree oblique projection.
- Foot rotated enough to open the lateral joint spaces.
- Interphalangeal and metatarsophalangeal joints partially open.
- Metatarsal bases and heads clearly demonstrated.
- Bone trabeculae sharp, no motion artifact.
- Collimation: 1 inch on all sides of toes.
Common errors / ARRT traps
- 1 Insufficient obliquity fails to open lateral joint spaces.
- 2 Rotating the foot too far creates lateral oblique instead of medial.
- 3 Centering off the mid-foot clips toes from collimation.
- 4 Allowing the foot to flex closes the MTP joints.
Clinical indications
- Trauma evaluation when AP alone is inconclusive.
- Assessment of toe alignment or lateral deformity.
- Evaluation of the medial tarsal structures.
Aligned to the 2025 ARRT Content Specifications.