Ankle Profile:
Anteroposterior (AP), lateral, and mortise (an oblique view with the foot internally rotated 15 to 20 degrees) views
are standard. A mortise view in medical imaging is a specialized X-ray projection of the ankle joint. It's obtained by
internally rotating the foot 15-20 degrees, which allows for a clear visualization of the space between the talus,
medial malleolus, and lateral malleolus, called the "mortise".
A. Tibiofibular overlap (AP View) → TFO
overlapping area between the anterior distal tibial prominence and the medial edge of the distal fibula.
- Function
Together with the TFCS and the medial clear space, the tibiofibular overlap space has been used in the diagnosis
and syndesmotic injury and the syndesmotic assessment after repair.
- Measurement
This measurement can be made on AP or mortise projections. The horizontal distance between the lateral margin
of the anterior tubercle and the medial contour of the fibula is measured parallel and about 1 cm above the distal
tibial plafond in a normal AP view of the ankle.
- Interpretation
In the context of an enlarged tibiofibular clear space and a widened medial clear space, a tibiofibular overlap of
<0 mm is considered abnormal although has been reported as a normal variant.
B. Tibiofibular clear space (AP view) → TFCS
a radiographic measure and defined as the space between the groove of the distal tibial prominence and the
medial margin of the distal fibula.
Function: Together with the TFO and the medial clear space, the tibiofibular clear space has been used in the
diagnosis of syndesmotic injury and the assessment of its repair
Measurement: on AP or mortise view of the ankle. Measured 1 cm above the tibial plafond. It is described as the
horizontal distance between the deepest point of the fibular groove or posterior tibial tubercle and the medial
edge of the distal fibula.
Interpretation: In the context of an absence of any tibiofibular overlap (TFO <0) and a widened medial clear
space, a horizontal distance of >6 mm has been considered abnormal.
C. Medial Clear Space (AP view)
radiographic measurement that may be useful in the diagnosis of ankle stability, instability, syundesmotic injuries
and ankle fracture.
- Function
The medial clear space is used in the prediction of deltoid ligament injury and in conjunction with
the TFCS, the TFO and the superior clear space in the diagnosis of syndesmotic injury.
- Measurement
The widest distance between the lateral border of the medial malleolus and the medial side of the talus
and is usually measured parallel to the superior talar articular surface. This can be measured at the level
of the talar dome (common) or 5 mm inferior to the talar dome.
- Interpretation
A medial clear space of ≥4-5 mm has been considered abnormal although there is criticism that the
measurement is inaccurate and imprecise
D. Talocrural angle (Mortise view)
The talocrural angle is measured on the mortise view as the angle between a line along the distal tibial plafond
articular surface and another line joining the tips of both malleoli.
• normal: 83° ± 4° 2 or 8-15° 3
• fibular shortening: >2° difference to the contralateral side
E. Talar Tilt (Mortise view)
measurement of the angle between the talus and the distal tibia, used in the assessment of ankle
instability and OA Ankle.
- Function:
Talar tilt is an important measurement in the assessment of ankle osteoarthritis. It is measured as part
of the Kellgren Lawrence of OA Ankle, as modified for the ankle joint. It is also important in preoperative
evaluation, as the management of ankle osteoarthritis by total ankle arthroplasty necessitates the
correction of that tilt (typically a varus tilt) at surgery.
- Measurement:
Talar tilt is measured on either mortise view radiographs of the ankle. Talar tilt is the angle between the
articular surface of the talar dome and the articular surface of the tibial plafond 3. The tilt may be
either varus or valgus
- Interpretation:
normal values
o <2° on non-stress radiographs
o <5° on inversion stress radiographs
talar tilt ≥2° upgrades Kellgren and Lawrence ankle OA from grade 3a to 3b, which is associated with
worse clinical outcomes.
A. Medial Clear Space
B. Talocrural angle
C. Talar tilt angle
D. Mortise view showing shenton line
E. Syndesmotic width
