OBJECTIVE. Extremity cone-beam CT (CBCT) scanners have become available for clinical use in the United States. The purpose of this study was to review an initial clinical experience with CBCT of the foot and ankle in pediatric patients. MATERIALS AND METHODS. A retrospective review was conducted of all foot or ankle CBCT examinations performed on patients 18 years old and younger at one institution from August 1, 2013, through February 28, 2015. A t test was used to compare mean effective dose for CBCT with that for MDCT foot or ankle examinations of age-matched control subjects. To assess changes in utilization, a t test also was used to compare the mean numbers of foot or ankle CT examinations per month before and after installation of the CBCT scanner at the institution. RESULTS. Thirty-four CBCT examinations were performed. The mean effective dose was 0.013 ± 0.003 mSv compared with 0.023 ± 0.020 mSv for MDCT of age-matched control subjects (p < 0.005). The mean numbers of foot or ankle CT examination...