Ottawa Ankle Rules

Other Names

Ottawa Ankle Rules

Illustration of the Ottawa Ankle Rules^[1]

Decision making tool to determine if radiographs are indicated for acute, traumatic foot or ankle pain
Assesses Medial Malleolus, Lateral Malleolus, 5th Metatarsal, Navicular

An Ankle X-ray is only required if:

There is any pain in the malleolar zone; and,
Any one of the following:
- Bone tenderness along the distal 6 cm of the posterior edge of the tibia or tip of the medial malleolus, OR
- Bone tenderness along the distal 6 cm of the posterior edge of the fibula or tip of the lateral malleolus, OR
- An inability to bear weight both immediately and in the emergency department for four steps.

A Foot X-ray series is indicated if:

There is any pain in the midfoot zone; and,
Any one of the following:
- Bone tenderness at the base of the fifth metatarsal (for foot injuries), OR
- Bone tenderness at the navicular bone (for foot injuries), OR
- An inability to bear weight both immediately and in the emergency department for four steps.

↑ ^1.0 ^1.1 Bachmann LM, Kolb E, Koller MT, Steurer J, ter Riet G. Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review. BMJ. 2003;326(7386):417.

Created by:

John Kiel on 7 August 2019 14:30:55

Authors:

Last edited:

22 April 2023 22:34:54

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