Emergency Medicine

Ottawa Ankle Rules

Whether ankle/foot X-rays are needed after injury.

Education and reference only. Not a substitute for clinical judgement, local policy or product labelling. Always verify before clinical use. Values are calculated in your browser and never stored.

When to use

Use after acute ankle/midfoot injury to decide whether X-rays are required. If NO criteria are present, a clinically significant fracture is very unlikely.

Why use

It safely reduces unnecessary ankle and foot radiographs.

Advice

Ankle X-ray is indicated for malleolar-zone pain with malleolar tenderness or inability to weight-bear; foot X-ray for midfoot pain with 5th metatarsal/navicular tenderness or inability to weight-bear.

Evidence & references

Stiell IG et al. Decision rules for the use of radiography in acute ankle injuries. JAMA. 1993.

About the creator

Stiell IG et al.

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