• Patient supineon the X-ray table or barouche
  
• Flex the knee of the affected leg
• Place IR under foot parallel to its long axis
• Internally (medially) rotate the leg until the plantar surface is at a 45° angle to the IR (refer to Special Notes below)
• Use a sponge for stabilising the foot in this position

• PACEMAN

• The correct obliquity is evidenced by

1. the 1st and 2nd metatarsals should only be superimposed at the bases
2. 3rd through 5th metatarsals should not be superimposed
3. base of the 5th metatarsal (tuberosity) should be well shown
4. the tarsal sinus is well shown
   
5. joint spaces around the cuboid are open
6. the cuboid is seen in profile
   

• The entire foot should be demonstrated to show all phalanges, metatarsals, calcaneum and proximal talus

• Centre: The base of the third metatarsal
• Shutter A: Open to include the outer skin margins of the lateral and medial sides of the foot
• Shutter B: Open to include the soft tissue of the toes and the proximal calcaneus

• Bony trabecular patterns and cortical outlines are sharply defined
• Soft tissues are visualised
• Correct use of a filter will give uniform density of phalanges and metatarsals

• the base of the 5th metatarsal is superimposed over the tubercle of the 4th metatarsal
  
• the joint space between the 4th and 5th metatarsals is closed

• the base of the 4th metatarsal is superimposed over the base of the 5th metatarsal
  
• the joint space between the 4th and 5th metatarsals is closed

• This angle will vary according to the arch of the foot.
• 45° for a normal arch
• 30° for a low arch
• 60° for a high arch