Positioning Challenges of the Lower Extremity/ Radiography

PositioningChallenges of the Lower Extremity/ Radiography

PositioningChallenges of the Lower Extremity/ Radiography

Lowerextremity joint pain is a normally reported symptom in the primarycare milieu. There are several common musculoskeletal ailments of thelower extremities which usually result to joint pain, including thefoot, ankle, knee and hip (Karnath, 2003).


Hippain is categorized into anterior, posterior or lateral. Anterior hippain is an indication of intra-articular disease. Osteoarthritis isthe most common diagnosis in patients aged above 50 years. Anteriorhip pain may also be caused by hip fracture or avascular necrosis.

Lateralhip pain can be as a result of iliotibial band syndrome, tronchatericbursitis, meralgia paresthetica, or entanglement of the lateralfemoral cutaneous nerve (Karnath, 2003). A person suffering from thiscondition usually experience pain while walking or rolling intosides.

Posteriorhip pain usually occurs due to irritation of sciatic nerve orirritation of nerve root from lumber disc disease. Patients usuallyexperience dull unilateral ache through the thigh and buttocks.


Diagnosisof knee pain is best achieved if the patient is in supine position.Initial exams include checking for swelling, lacerations, bruising,deformity or erythema. Palparation is used to establish warmth andeffusion (Karnath, 2003).

Ligamentousinjury causes knee trauma. Normally, knee injuries are not related tofracture. Thus the focus on examination in a patient of knee traumashould be on the stability of ligamentous. Acute decelerationnormally leads to injury of anterior cruciate ligament.


Acuteinjury often results to ankle pain. The most probable mechanism ofinjury of the ankle is plantar flexion and inversion. In thisscenario, the most commonly affected ligaments are thecalcaneofibular ligament and the anterior talofibular ligament(Karnath, 2003).


Footpain can be focused on the forefoot, hind-foot and the mid-foot.

Painof the plantar surface of the forefoot area of the forefoot isdescribed as metatarsalgia. Usually, pain worsens with bearing ofweigh and it’s commonly reduced by resting. Patients experience afeeling of walking with a pebble inside the shoe. Tenderness in theaffected metatarsals is revealed through palpation of the metatarsalhead.

Mid-footis commonly caused by plantar fasciitis. Medial calcaneal tuberclepalpation causes the pain. Pain is situated in the inferior medialelement of the calcaneus (Karnath, 2003). Symptoms include feeling ofpain during the first few steps of walking, which lessens withincreased walking.

Hindfootpain is commonly caused by retrocalcaneal bursitis and Achillestendonitis which all present with warmth, pain and erythema.Dorsiflexion leads to compression of the bursa, resulting to pain ofthe retrocalcaneal bursitis (Karnath, 2003).

Varioustests are used to determine the positioning challenges of extremity.There are different ways of overcoming positioning strategies. Forexample, the treatment paradigm for lower extremity occlusive diseasedepends on percutaneous transluminal angioplasty (PTA) to produceluminal integrity. The cross-sectional area of the artery is enhancedby PTA, through subtotal rupture of the vessel which breaks theintima, plaque, and media down to the point of the adventia (Karnath,2003).

Dependingon the type of positioning challenge, different therapies can beapplied to reduce or address these challenges. Positioning challengesare quite common forms of conditions affecting the lower extremity.The areas which involve lower extremity include the foot, the ankle,the knee and the hip. The symptoms of these challenges are varied,hence the examination. Nevertheless, visiting a physician in goodtime can help reduce pain significantly and address the positioningchallenges.


Karnath,B. (2003). Common musculoskeletal problems of the lower extremities.HospitalPhysician.24-25.