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Ankle X-ray

Curious about your upcoming radiology exam? This post provides clear, patient-friendly information to help you understand what to expect, how to prepare, and what your results might mean.
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Introduction

Quick Takeaways

  • An Ankle X-ray is a fast radiographic exam that images the bones of the ankle joint.
  • It’s usually the first test after sprains, twists, or falls.
  • It’s excellent for showing fractures and alignment problems but does not show ligaments or tendons well.

Short introduction

An Ankle X-ray is a brief, non-invasive scan that uses low-dose ionizing radiation to capture images of the bony structures around the ankle. Because the ankle is commonly injured, X-rays are often the initial investigation to confirm or rule out fractures, dislocations, and some degenerative changes. For soft-tissue injuries (ligaments, tendons, cartilage), more advanced imaging such as MRI may be required.

Frequently Asked Questions

When is an Ankle X-ray recommended?

Your clinician may order an ankle X-ray if you have:

  • A recent injury with pain, swelling or inability to bear weight
  • Obvious deformity after trauma (possible dislocation)
  • Persistent or unexplained ankle pain or swelling
  • Suspected arthritis or long-standing joint problems
  • Signs that suggest bone infection or a mass
  • Follow-up after ankle surgery to check healing or hardware placement

 

What parts of the ankle are seen on the X-ray?

An ankle X-ray typically shows:

  • The lower ends of the tibia and fibula (shin bones)
  • The talus (the primary ankle bone) and nearby tarsal bones (including parts of the calcaneus)
  • Joint spaces and bone surfaces where wear or narrowing may indicate arthritis
Note: muscles, ligaments and nerves are not well visualized on plain X-rays

How should I prepare?

No special prep is usually necessary. Typical instructions may include the following:

  • Remove shoes, socks and any jewellery or metal around the ankle.
  • Wear loose clothing that’s easy to roll up.
  • Tell staff if you are pregnant or think you might be.

 

Pregnancy and children — is it safe?

Pregnancy: Because the ankle is remote from the abdomen, fetal exposure is minimal. Still, X-rays are avoided in pregnancy when possible; if essential, protective abdominal shielding is used and the physician will weigh risks versus benefits.

Children: Ankle X-rays are commonly and safely used in children; your Radiographers are trained to use X-rays appropriately and keep dose as low as possible.

What happens during the test?

You’ll be seated, lying, or standing and asked to place your foot on the X-ray plate in specific positions. The Radiographer will position the machine and take the X-ray exposures; during this process, you must remain still as instructed by your Radiographer. The exam is quick and does not require needles or injections.

Common Ankle X-ray Views

To evaluate the ankle fully, Radiographers commonly take multiple views, for example:

  • AP (anteroposterior) — front to back view
  • Lateral — side view for alignment and displacement
  • Mortise — an angled view that opens the joint space and shows the ankle mortise clearly
  • Special/weight-bearing views may be requested to assess joint space under load

Can I have an Ankle X-ray after surgery?

Yes — post-operative X-rays are routinely used to:

  • Confirm correct placement of screws, plates or other hardware
  • Monitor bone healing and alignment
  • Detect complications such as delayed union or infection
  • Surgeons can also order multiple follow-up X-rays after the initial one to track recovery.

Is the procedure painful or invasive?

No. The X-ray itself is painless and non-invasive. Any minor discomfort usually comes from holding a position or weight-bearing after injury.

What can an Ankle X-ray detect?

An Ankle X-ray has a wide range of uses. It can show:

  • Fractures or cracks in the bones
  • Dislocations or subluxations
  • Arthritis-related joint narrowing or bone spurs
  • Bone infections or suspicious lesions
  • Hardware placement and healing progress after surgery

What are the limits of an Ankle X-ray?

While Ankle X-rays can prove to be very useful, they do not reliably show ligament tears, tendon injuries, cartilage defects, or very subtle bone bruises. If these are suspected, despite normal X-rays, your clinician may recommend MRI, CT or ultrasound.

How long does it take and when will my results be ready?

The scan itself usually takes 5–10 minutes or even further, depending on the number of views.

Results are often available within hours to days after a radiologist reviews the images and issues a report. This practice varies among hospitals and diagnostic centers. Always make clear inquires about this before or after your test.

How often can I have ankle X-rays?

There’s no fixed maximum, this is because the radiation dose per exam is low. However, X-rays are performed only when medically justified, and clinicians are expected to avoid unnecessary repeat imaging.

When should I seek urgent care?

Seek immediate medical attention if you experience:

  • Severe deformity of the ankle
  • Inability to move or bear weight on the foot after trauma
  • Numbness, severe pain, or loss of circulation (cold, pale toes)
  • High fever with localized ankle pain (possible infection)

Conclusion

An Ankle X-ray is a fast, effective first step to identify many bone and alignment problems. If after your X-ray, your results suggest soft-tissue injury or a more complex issue, your doctor will arrange the appropriate advanced imaging.

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