A great, quick read from one of our fav’s: Dr Tom Michaud.
Here is my favorite excerpt. I had not thought of imaging the ankle quite this way
“Physical examination reveals pinpoint sensitivity over the anteromedial capsule. When the ankle is slightly plantarflexed, the osteophytes on the talus and tibia can be readily palpated. Surprisingly, lateral X-rays only identify approximately 40 percent of the talotibial spurs, because the natural torsion of the distal tibia obstructs direct visualization of the anteromedial tibia. To improve radiographic accuracy, van Dijk, et al., recommend oblique radiographs be taken with a 45-degree craniocaudal angle, with the lower extremity externally rotated 30 degrees. The authors demonstrated that oblique radiographs identify 73 percent of the spurs located on the talus and 85 percent of the spurs located on the distal tibia.”