Ok, so I've been pondering this for a minute and thought I'd toss it out here. 

My truck (2001 3500) has steel wheels with 7 hand holes in each wheel.

 I know the common practice is to offset the valve stems 180° from each other. On my wheels if I do this the inner stem is hiding behind the steel in between holes of the outer wheel and very difficult to get to. 

 I looked in the owners manual and it really didn't say much at all about this.

 If the tires are balanced separately before mounting to the axle would it really matter where the valve stwms are oriented? ( assuming the 180° offset is for balance purposes)

 I'd like to be able to easily get to both the inner and outer to adjust pressures to the state of load on the truck. 

 Thanks

Edited September 27, 20222 yr by Doubletrouble

If each wheel is balanced, it doesn't matter where you put the stems in my opinion. If you add one of those stem extension things to the inner wheel, that will throw everything off.

 Yeah, I knew that would throw things off. Honestly I don't fully trust those things. 

 Thinking maybe the valve stem caps that have a plunger so you can check and change pressure without removing the cap. Not sure what they're called exactly.

Alligator caps is what the srem caps are called. You can check, inflate or deflate through the valve stem cap. 

 I'm going to rotate my outer wheel to line up the inner stem with a hand hole so I can get in there with a gauge or tire inflator chuck and install alligator caps on the inner stem. I'll let everyone know how this works out. 

 Went for a short drive today. No vibrations and with the alligator caps I can now check and adjust tire pressure in the inner tire without trouble. The valve stem had to be in the same spot next to each other in order to have the best access to the inner stem.

Just a quick update, so far no bad vibes. I always assumed the valve stems had to be 180° off for balance, guess I was wrong. 

Back in the 70's the old 1976 Dodge Jamboree I had had the pin alignment for the wheels and the stem were required to be 180 out from each other and the pin ensured that it happened. That was back with steel wheels and 16.5 inch tires.