Toe X-ray (both feet)

What it is

A toe x-ray is a small, focused study — more than two projections of one or more toes, taken from the front, the side, and at an angle, so that the short bones of a toe are not stacked on top of each other in every image. The clinical value is in the details a general foot film blurs. A crack across the middle of a toe bone is generally treated by taping it to its neighbour and waiting; a crack that runs into the joint surface, or a toe that has been driven out of joint, is a different proposition, and the big toe carries more weight and more consequence than the others. Both feet are imaged when both are symptomatic, which is common in joint disease affecting the base of the big toe.

Why it is done

• To confirm a fracture in a toe and, more usefully, to show whether it extends into a joint surface
• To distinguish a fracture from a dislocation, which needs to be put back rather than taped
• To check alignment after a displaced toe has been manipulated straight
• To assess joint damage at the base of the big toe in arthritis or long-standing pain, where both feet are usually compared
• To locate a foreign object driven into a toe

What to expect

The foot is placed flat on the plate, with the toes sometimes separated by a sponge, and then angled or rolled for the remaining views. Each exposure is momentary; the appointment is a few minutes. No preparation, nothing afterward. A freshly injured toe is tender to position and a technologist will usually let you move it yourself. One thing worth knowing in advance: an early stress fracture in the forefoot often does not show at all, and a clear film does not necessarily end the question.

Questions worth asking

• Was this coded as a toe study or as a whole-foot study? They cover different amounts of the foot and are priced differently, and the bill should match what was imaged.
• If toes on both feet were filmed, is that one charge or two?
• If the treatment is taping regardless of the result, is a follow-up film planned, and what would it change?
• At an urgent care, is the x-ray folded into the visit charge or listed separately, and is the reading included?
• If a podiatrist takes and reads the film in their own office, is there still a separate radiologist fee?