Background Accurate and reliable measurement of full lower extremity alignment is very important for preoperative planning and postoperative assessment in corrective knee surgery such as high tibial osteotomies and arthroplasties. Traditionally, three separate AP images are obtained centered over the hip, knee and ankle joint, using three separate cassettes with three exposures. During the last 15 years a gradual change from traditional analog film radiographs to digital imaging has occurred. Objective To discuss the effectiveness of peripheral stepping angiography for full lower extremity alignment measurement. Methods A group of full lower extremity alignment images obtained by the peripheral stepping angiography with one exposure was studied. Two males and eleven females with 26 lower limbs suffered from OA, aged 48~75 (mean 62.23 years) were included. Two ways of images were taken, standing and supine position. One experienced orthopaedic surgeon measured on hard-copy radiographs, while one fellowship-trained radiologist measured on the monitor screen of the Carestream picture archiving and communication system (PACS), for evaluation of HKA angle. The data were analyzed with SPSS 18.0 version to evaluate the significant difference comparison and correlation coefficient between the measurements of mechanical axis deviation. Results This new technique for full lower extremity alignment measurement is of accuracy and reliability, the value of the difference between standing and supine position is below two degrees, the correlation coefficient for the measurement of mechanical axis deviation with the use of standing and supine position, as well as the manual and computer-assisted methods, was from good to excellent (r=0.638-0.975). Conclusions Peripheral stepping angiography for full lower extremity alignement is a fast, easy, convenient and effective examination. The computer-assisted digital image measurement, as well as manual measurement, seems of high accuracy and reliability for full lower extremity alignment measurement.