Ottawa ankle rules

• Nearly 100% sensitive
• Can reduce ED utilization of xrays

Ankle

• X-ray is only required if there is pain in the malleolar zone AND any of these findings:
  • Bony tenderness along the posterior edge or distal 6 cm of medial or lateral malleolus
  • Inability to bear weight immediately after injury AND for at least four steps at the time of ED or doctor's office evaluation

Foot

• X-ray is only required if there is pain in midfoot zone AND any of these findings:
  • Bony tenderness over the navicular bone
  • Bony tenderness over base of the 5th metatarsal
  • Inability to bear weight immediately after injury AND for at least four steps at the time of ED or doctor's office evaluation

Exceptions

1. Age <6 or >55
2. Only for blunt trauma mechanism
3. Does not apply to subacute/chronic injuries
4. Does not apply to injuries of the hindfoot or forefoot

Imaging

External Links

MDCalc - Ottawa Ankle Rules

See Also

• Ankle (Main)
• Ankle Fracture
• Foot Diagnoses
• Ottawa Ankle Rule Study
• Ottawa Knee Rules

Sources

1. Bachmann LM, Kolb E, Koller MT, et al. Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review. BMJ. 2003 Feb 22;326(7386):417.
2. Bauer SJ, Hollander JE, Fuchs SH, et al. A clinical decision rule in the evaluation of acute knee injuries.J Emerg Med. 1995 Sep-Oct;13(5):611-5.
3. Dowling S, Spooner CH, Liang Y, et al. Accuracy of Ottawa Ankle Rules to exclude fractures of the ankle and midfoot in children: a meta-analysis. Acad Emerg Med. 2009 Apr;16(4):277-87.
4. Stiell IG, Greenberg GH, McKnight RD, et al. A study to develop clinical decision rules for the use of radiography in acute ankle injuries. Ann Emerg Med. 1992 Apr;21(4):384-90.
5. Stiell IG, McKnight RD, Greenberg GH, et al. Implementation of the Ottawa ankle rules. JAMA. 1994 Mar 16;271(11):827-32.
6. Stiell I, Wells G, Laupacis A, et al. Multicentre trial to introduce the Ottawa ankle rules for use of radiography in acute ankle injuries. Multicentre Ankle Rule Study Group. BMJ. 1995 Sep 2;311(7005):594-7.