Ottawa ankle and foot rules
Whether an ankle or foot X-ray is needed after injury.
Inputs
Bone tenderness: lateral malleolus (posterior edge or tip)
Bone tenderness: medial malleolus (posterior edge or tip)
Bone tenderness: base of the fifth metatarsal
Bone tenderness: navicular
Unable to bear weight for 4 steps, both immediately and in the ED
Worked calculation
Your values are highlighted.
- Criteria present
When to use
- Acute ankle or midfoot pain after injury.
Pearls and pitfalls
- Applies only with pain in the malleolar zone (ankle) or midfoot zone (foot).
- Bone tenderness is at the posterior edge or tip of the distal 6 cm of either malleolus.
Why use
Cuts ankle X-rays by about a third with near 100% sensitivity.
Positive if any criterion is present