American Orthopaedic Foot & Ankle Society
View all recommendations from this societyReleased September 17, 2014; Revised January 15, 2021
Avoid non-weightbearing X-ray evaluation of the foot and ankle when patients are able to stand.
The functional position of the foot and ankle is one of weightbearing. Foot and ankle deformity may be decreased or absent on non-weightbearing x-rays as compared to weightbearing x-rays. Therefore, foot and ankle disorders including flatfeet, ligamentous injuries of the midfoot, ankle arthritis, bunions, and hammertoes that are well-demonstrated on weightbearing x-rays may be underestimated or not appreciated at all on non-weightbearing x-rays. Therefore, when possible, weightbearing x-rays of the foot and ankle are preferred in order to 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 to prepare an initial list of topics for the Choosing Wisely website. 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. The finalized list was then reviewed and approved by the AOFAS Board of Directors.
For more information, visit www.aofas.org.
Sources
Boszczyk A et al, Non-weightbearing compared with weightbearing x-rays in hallux valgus decision-making. Skeletal Radiology. 2020; 49:1441–1447.
de Cesar Netto C et al, Consensus for the Use of Weightbearing CT in the Assessment of Progressive Collapsing Foot Deformity. Foot Ankle Int. 2020;41(10):1277-1282.
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 osteoarthritis with physical performance. Osteoarthritis and cartilage / OARS,
Osteoarthritis Research Society. 2011;19(6):634–8.
Shelton T et al, The Influence of Percentile Weight Bearing on Foot Radiographs. Foot and Ankle Specialist. 2019; Aug;12(4):363-369
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.
