The Ottawa Ankle Rules

Many clients present with severe ankle sprain. In order to decide on x-ray or not, we use the Ottawa Ankle Rule: An Ankle X-Ray series is only required if:

There is any pain in the malleolar zone (defined more or less) from the tibia and fibula 6 cm above the articulation with the talus, to the bones of the midfoot AND any of these findings:

a) Bone tenderness at the posterior edge or tip of the lateral malleolus OR
b) Bone tenderness at the posterior edge or tip of the medial malleolus OR
c) Inability to bear weight both immediately and in the ED

A foot X-Ray series is required only if:

There is any pain in midfoot AND any of these findings:

a) Bone tenderness at the base of the 5th metatarsal OR
b) Bone tenderness at the navicular OR
c) Inability to bear weight both immediately and in the ED

These rules have been demonstrated to have high sensitivity and can be used with good effect when a clinician is deciding to x-ray an ankle or not.

Ref (Hayworth J. BJSM: 2003;37:194)

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