Determining X-ray Plate Position on Lateral Foot Radiographs

Key Radiographic Indicators

• When the great toe is down (lateral-side-down), the hallux sesamoids are typically better visualized and more clearly separated on the lateral projection, according to the American College of Radiology 1
• Standard lateral foot radiographs should demonstrate proper tibiotalar alignment regardless of positioning, but the overall foot architecture helps confirm orientation, as noted by the American College of Radiology 2, 3

Clinical Context and Standard Positioning

• Standard lateral foot radiographs are typically obtained with the medial side down (5th toe against the plate), which is the most common positioning for routine foot imaging, as recommended by the American College of Radiology 1, 4
• When weight-bearing lateral radiographs are obtained, consistent positioning is essential for detecting subtle malalignment, according to the American College of Radiology 1, 4