In the Holly method for tangential sesamoids, which action is performed?

• A. Dorsiflex the foot
• B. Seated on the radiographic table
• C. Standing with the foot extended
• D. Rotate the foot medially

Answer: (A)

Dorsiflex the foot. In the Holly method for tangential imaging of the sesamoids, the goal is to produce a tangential projection of the first metatarsophalangeal joint so the sesamoid bones are seen without overlapping other structures. Dorsiflexion lifts the toes toward the shin, bringing the plantar surface closer to the imaging plane and aligning the beam tangentially to the plantar aspect. This position minimizes superimposition by the metatarsal head and opens up the view of the sesamoids, making them appear clearly on the radiograph. Rotating the foot medially, extending rather than dorsiflexing, or simply seating/standing without the necessary dorsiflexion do not achieve this tangential alignment.