Background: Intraoperative evaluation of hindfoot alignment is one of the factors that may affect outcomes for foot and ankle reconstructive surgery. The present study was performed to evaluate the effect of simulated weightbearing fluoroscopy on the intraoperative assessment of hindfoot alignment reconstruction. Methods: The medical records of patients diagnosed with disorders of the foot and ankle with abnormal hindfoot alignment were retrospectively reviewed from November 2014 to November 2021. Hindfoot alignment view (HAV) fluoroscopy in the simulated weightbearing position and HAV radiographs were routinely recorded during and after surgery, respectively. The hindfoot alignment angle (HAA) and hindfoot alignment ratio (HAR) were measured on intraoperative and postoperative images, respectively. Results: Seventy-two women and 82 men (155 ankles) with a mean age of 45.48 years were included in the present study. The intraobserver and interobserver reliabilities of the HAA and HAR measurements were satisfactory. The intraoperative and postoperative HAA was −0.7 ± 4.8 degrees and −0.2 ± 5.0 degrees, respectively. The mean HAR on intraoperative fluoroscopy and postoperative radiographs was 37.4% ± 19.7% and 40.4% ± 18.2%, respectively. Simple regression analysis revealed a correlation between the intraoperative and postoperative HAA ( R2 = 0.631, P < .001) and HAR ( R2 = 0.262, P < .001). Univariate analysis suggested that the difference between the intraoperative and postoperative HAA was positively affected by the body mass index ( P < .001). Conclusion: The present study showed that intraoperative HAV fluoroscopy in the simulated weightbearing position is a potentially useful method to predict postoperative hindfoot alignment in the weightbearing position. Patients with a lower body mass index had smaller HAA deviations between intraoperative and postoperative measurements of hindfoot alignment. Level of Evidence: Level IV, retrospective case series.