American Orthopaedic Foot & Ankle Society

View all recommendations from this society

Released September 17, 2014

Avoid X-ray evaluation of the foot and ankle without standing (weightbearing) in the absence of injury.

The functional position of the foot and ankle is one of weightbearing. When compared to non-weightbearing X-rays, deformities of the forefoot, midfoot and hindfoot have been shown to increase on weightbearing X-rays. In addition, narrowing of the ankle joint space on standing X-rays is associated with symptoms of arthritis. Therefore, weightbearing X-rays, when possible, give the most accurate assessment of the functional bony anatomy of the foot and ankle.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their health care provider.

How The List Was Created

In order to formulate this list, the American Orthopaedic Foot & Ankle Society Evidence-Based Medicine Committee reviewed the society position statements on foot and ankle care and solicited expert opinion from specialty leaders including the AOFAS Board of Directors to prepare an initial list of topics for the Choosing Wisely website. The Board of Directors of the AOFAS reviewed the initial list and approved five statements for further development. The Evidence-Based Medicine Committee members reviewed the scientific literature on each statement and presented draft statements with supporting evidence to the committee for discussion. Committee members also reviewed the Choosing Wisely campaign website to ensure that there was no duplication in proposed content and for proper formatting. The committee evaluated each statement and edited the statement wording and supporting references. Once consensus was reached, the 2014 list was finalized by committee members. The finalized list was then reviewed and approved by the AOFAS Board of Directors. The AOFAS disclosure and conflict of interest policies may be found at

Evidence-Based Medicine Committee:
Sandra E. Klein, MD, Chair
Ian J. Alexander, MD
Avrill R. Berkman, MD
Patrick B. Ebeling, MD
Todd S. Kim, MD
Anthony Michael Perera, MBChB
Phinit Phisitkul, MD
Ruth L. Thomas, MD
Emilio Wagner, MD
James A. Meeker, MD

AOFAS Board of Directors:
Steven L. Haddad, MD, President
Bruce J. Sangeorzan, MD, President-Elect
Mark E. Easley, MD, Vice President
Thomas H. Lee, MD, Secretary
Jeffrey E. Johnson, MD, Treasurer
Lew C. Schon, MD, Immediate Past President
Judith F. Baumhauer, MD, MPH, Past President
Bruce E. Cohen, MD, Member-at-Large
Timothy R. Daniels, MD, Member-at-Large
Sheldon S. Lin, MD, Member-at-Large
Selene G. Parekh, MD, MBA, Member-at-Large


Keim HA, Ritchie GW. Weight-bearing roentgenograms in the evaluation of foot deformities. Clin Orthop Relat Res. 1970;70:133–6.

Kitaoka HB, Lundberg A, Luo ZP, An KN. Kinematics of the normal arch of the foot and ankle under physiologic loading. Foot Ankle Int. 1995;16(8):492–9.

McDaniel G, Renner JB, Sloane R, Kraus VB. Association of knee and ankle ost eoarthritis with physical performance. Osteoarthritis and cartilage / OARS,Osteoarthritis Research Society. 2011;19(6):634–8.

Tanaka Y, Takakura Y, Takaoka T. Radiographic analysis of hallux valgus in women on weightbearing and nonweightbearing. Clin Orthop Relat Res. 1997;(336):186–4.