Which projection is best to visualize the lateral view of the ankle?

• A. AP mortise
• B. Medial oblique
• C. AP ankle
• D. Lateral ankle

Answer: (D)

To see the ankle in true lateral, you want a projection that presents the bones in profile and reveals how the distal tibia, fibula, talus, and calcaneus relate to one another from the side. The lateral ankle projection positions the patient on their side with the knee slightly flexed and the foot dorsiflexed just enough to place the ankle in a neutral, true lateral. The x-ray beam is directed horizontally and perpendicular to the ankle so the distal tibia and fibula appear superimposed while the posterior aspects of the talus and calcaneus are clearly visible. This orientation is ideal for assessing ankle joint congruity, the alignment of the malleoli, and any fracture lines or displacements that affect the posterior aspect of the ankle, as well as occult dislocations. In contrast, other views like AP mortise or AP ankle don’t provide this side-on perspective and thus can obscure posterior relationships or fine malleolar details.