Curriculum · Musculoskeletal / Orthopedic / Rheumatology
Ottawa ankle rules
What it is
The Ottawa foot and ankle rules should be used to determine the need for radiographs in foot and ankle injuries. They are up to 99% sensitive for detecting fractures, although they are not highly specific.
How it is diagnosed
A radiograph of the ankle is recommended if there is pain in the malleolar zone along with the inability to bear weight for at least four steps immediately after the injury and in the physician's office or emergency department, or tenderness at the tip of the posterior medial or lateral malleolus. A radiograph of the foot is recommended if there is pain in the midfoot zone along with the inability to bear weight for four steps immediately after the injury and in the physician's office or emergency department, or tenderness at the base of the fifth metatarsal or over the navicular bone. The same rule is put as pain at the malleolar site with any of the following: cannot bear weight for at least 4 steps immediately after trauma or at the time of evaluation, tenderness over the medial malleolus, or tenderness over the lateral malleolus.