What is the recommended central ray location for a lateral calcaneus radiograph?

• A. 1 inch distal to medial malleolus
• B. 1 inch proximal to medial malleolus
• C. At the level of the ankle joint
• D. At the distal third of the tibia

Answer: (A)

For a lateral calcaneus view, the central ray should be directed perpendicular to the calcaneus and aimed to enter about 1 inch distal to the medial malleolus. This location aligns the beam with the body of the calcaneus and the subtalar joint, giving a true lateral image that clearly shows the calcaneal body, fans out to the talus, and can reveal fractures or other pathology without distortion.

If the CR were placed proximal to the medial malleolus, the image would be higher and the calcaneus could appear foreshortened or not fully visible. If the CR were at the level of the ankle joint, you’d risk missing parts of the posterior facet and distal calcaneus. Pointing too far distal toward the tibia would shift the beam away from the calcaneus itself. Therefore, entering 1 inch distal to the medial malleolus best centers the calcaneus on the image and provides the needed visualization.