When should I see a podiatrist?

You should see a podiatrist for any persistent foot or ankle pain lasting more than a few days, difficulty walking, numbness or tingling, wounds that won't heal, changes in skin color or temperature, or structural deformities. Dr. Tom Biernacki, DPM is a board-certified podiatrist serving SE Michigan with same-day appointments available. Call 810-206-1402.

Does Dr. Biernacki accept insurance?

Balance Foot & Ankle accepts most major insurance plans including Blue Cross Blue Shield, Aetna, United Healthcare, Cigna, Medicare, and many others. Contact our office at 810-206-1402 to verify your specific coverage. We also offer affordable self-pay options.

What should I expect at my first podiatry appointment?

Your first visit includes a comprehensive evaluation with Dr. Biernacki including medical history review, physical examination, biomechanical assessment, and any necessary diagnostic imaging (X-rays are available in-office). You'll receive a diagnosis, treatment plan, and same-day treatment when possible. Most initial visits take approximately 30-45 minutes.

Medically Reviewed by Dr. Jeffery Agnoli, DPM — Board-Certified Podiatrist, Balance Foot & Ankle Specialists, Michigan. Last updated April 2026.

Foot & Ankle X-Rays: What Your Podiatrist Is Looking For

Name: X-Ray of Foot & Ankle: What to Expect | Podiatrist
Creator: Dr. Tom Biernacki, DPM
Published: 2026-03-23T08:14:07-04:00

At Balance Foot & Ankle, we have in-office digital X-ray at both locations — same-day imaging without a separate radiology appointment. Many patients wonder what we’re actually looking for when we take foot X-rays. This guide explains the key views and what we assess with each.

Why Foot X-Rays Are Different from Other Body Part X-Rays

Foot imaging has unique considerations that affect how films should be taken and interpreted:

Weight-bearing vs. non-weight-bearing: The foot changes significantly when loaded with body weight. Non-weight-bearing X-rays can miss deformities that only appear with loading. Standard of care for most foot and ankle conditions is weight-bearing imaging.
Bilateral comparison: Many structural measurements require comparison to the opposite foot to distinguish normal variant from pathology.
Multiple views essential: No single X-ray view shows everything. Standard foot series includes at minimum: AP (front to back), lateral (side view), and oblique views.

Standard X-Ray Views and What We Assess

Weight-Bearing AP (Anteroposterior) View — Foot from Above

What we look at:

1st MTP joint: Hallux valgus angle, joint space narrowing (bunion/arthritis assessment)
Inter-metatarsal angle: Width of spread between metatarsals — key metric for bunion correction planning
Metatarsal length pattern: Index plus, index minus — affects forefoot loading
Tarsometatarsal joints: Lisfranc injury assessment — subtle widening at the 1st/2nd metatarsal base gap is a key sign
Navicular position: Deviation from normal alignment
Sesamoids: Position, fracture, bipartite sesamoid

Weight-Bearing Lateral View — Foot from Side

What we look at:

Arch height: Calcaneal pitch angle (normal 18–30°); Meary’s angle (talo-1st metatarsal angle) — ideally 0°; negative = flat foot, positive = cavus
Calcaneus position: Angle of inclination
Talocalcaneal relationship: Hindfoot valgus/varus
Heel spur: Inferior (plantar) or posterior calcaneal spurs
Achilles tendon: Haglund’s deformity (prominent posterior calcaneal angle)
Joint spaces: Talonavicular, calcaneocuboid, tarsometatarsal

Oblique View

Provides visualization of the cuboid, lateral cuneiform, 4th and 5th metatarsal bases, and tarsometatarsal joints at an angle that neither AP nor lateral shows well. Important for: Jones fracture (5th metatarsal base), subtalar joint, and midfoot arthritis.

Ankle Views (AP, Mortise, Lateral)

Mortise view: Critical for seeing the ankle joint space evenly — reveals medial clear space widening (high ankle sprain/syndesmosis injury)
Talar tilt: Stress films assess lateral ligament integrity
OLT assessment: Osteochondral lesions visible on lateral or mortise views

Calcaneal Axial View

Looking at the heel end-on. Used to assess calcaneal fractures, subtalar joint, and posterior calcaneal tuberosity. Also the best view for sesamoid assessment in the “skyline” position.

Key Measurements Podiatrists Use

Hallux valgus angle: Normal <15°; mild 15–20°; moderate 20–40°; severe >40°
1st intermetatarsal angle: Normal <9°; guides bunion correction technique selection
Tibiotalar angle: Assesses ankle joint alignment
Calcaneal pitch: Low angle = flatfoot; high angle = cavus

When X-Rays Aren’t Enough: Advanced Imaging

X-rays show bones and joints but cannot show soft tissue pathology. MRI is indicated for:

Tendon tears (Achilles, posterior tibial, peroneal)
Plantar plate tears
Osteochondral lesions of the talus (though X-ray may show them in advanced cases)
Stress reactions before they become visible fractures
Ligament tears (spring ligament, ankle ligaments)
Nerve entrapment (Morton’s neuroma, tarsal tunnel)

Ultrasound is ideal for dynamic tendon assessment, plantar fascia thickness measurement, and Morton’s neuroma identification in experienced hands.

Ready to Get Relief? We’re Here to Help.

Board-certified podiatrists Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients daily at our Howell and Bloomfield Township, MI offices.

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