What is the standard foot position for a lateral foot x-ray (x-ray)?

Standard Foot Position for Lateral Foot X-ray

For a lateral foot radiograph, the patient should be positioned with the foot placed medially (on its medial side) with the lateral aspect of the foot against the image receptor, ideally obtained in a weight-bearing (standing) position when feasible. 1

Patient Positioning

Standard Lateral View Setup

• The patient lies supine on the table for lateral foot imaging 1
• The foot is rotated so that the medial side is elevated and the lateral border rests flat against the cassette/detector 1, 2
• The central ray is directed perpendicular to the image receptor, centered at the base of the third metatarsal 3

Weight-Bearing vs Non-Weight-Bearing

• Weight-bearing (standing) lateral radiographs are strongly preferred as they detect dynamic abnormalities such as joint malalignment, subluxation, and structural changes not visible on non-weight-bearing films 1, 2, 4
• Non-weight-bearing lateral views are acceptable only when the patient cannot stand due to limited mobility or when there is risk of fracture displacement 1, 4
• The three standard foot views (anteroposterior, medial oblique, and lateral) should all be obtained as weight-bearing films when possible 1, 2

Complete Standard Foot Series

Three-View Protocol

The lateral view is part of a standardized three-view foot series that includes: 1, 2

• Anteroposterior (AP) projection
• Medial oblique projection
• Lateral projection

Clinical Context for Ordering

• Specify "weight-bearing" on the requisition unless contraindicated 1, 2, 4
• Request bilateral comparison films when evaluating for Charcot neuro-osteoarthropathy or subtle pathology 1, 2
• Include clinical indication (e.g., "rule out fracture," "evaluate deformity") to guide radiologist interpretation 2

Critical Technical Considerations

Avoiding Measurement Errors

• Proper alignment is essential—transverse plane misalignment of the X-ray source significantly affects measurements like the calcaneal pitch angle on lateral views 5
• The lateral talometatarsal angle (LTMA) is more reliable than calcaneal pitch angle and less sensitive to positioning errors 5
• Consistent patient positioning at baseline and follow-up is crucial for accurate comparison of serial radiographs 1, 5

Key Anatomic Landmarks Visible on Lateral View

The lateral foot radiograph should adequately visualize: 3

• Talus and calcaneus relationship (talocalcaneal angle)
• Talar declination and calcaneal pitch
• Lateral talometatarsal angle
• Midfoot alignment and arch configuration

Common Pitfalls to Avoid

• Do not skip weight-bearing views when the patient can stand—non-weight-bearing films miss critical functional alignment information 1, 2, 4
• Do not accept poorly positioned lateral views where the medial and lateral malleoli are not superimposed or the talus and calcaneus are rotated 5
• Do not order only "toe films" when evaluating foot pathology—the complete three-view foot series provides necessary anatomic context 2
• Do not rely solely on radiographs in high-risk patients (diabetics, elderly) as fractures may be occult on plain films 2, 4