Which projection is used to view the sesamoid bones beneath the head of the first metatarsal?

• A. AP Foot
• B. Tangential projection of the toes for sesamoids
• C. Lateral Foot
• D. Oblique Foot

Answer: (B)

To clearly image the sesamoid bones beneath the head of the first metatarsal, you need a view that places the sesamoids in true profile and minimizes overlap with the metatarsal head. The tangential projection of the toes for sesamoids achieves this by directing the x-ray beam tangentially to the plantar surface, with the toes flexed so the ray passes just under the first MTP joint. This angle releases the sesamoids from superimposition and makes their shape, position, or any pathology (like fractures or bipartite sesamoids) much easier to assess. Other projections don’t provide this true tangential view: the AP foot view tends to bury the sesamoids beneath the metatarsal head, lateral shows a side view that doesn’t align tangentially with the plantar surface, and oblique still doesn’t place the sesamoids in a true tangent relation.