Ottawa Ankle Rule
Rules out clinically significant foot and ankle fractures to reduce use of x-ray imaging.
Advice
- If ankle pain is present and there is tenderness over the posterior 6 cm or tip of the lateral or medial malleolus, then ankle x-ray is indicated.
- If midfoot pain is present and there is tenderness over the navicular or the base of the fifth metatarsal, then foot x-ray is indicated.
- If there is ankle or midfoot pain and the patient is unable to take four steps both immediately and in the emergency department, then x-ray of the painful area is indicated.
Management
- X-ray.
- RICE plan (Rest, Ice, Compression, Elevation).
- Splinting/crutches and pain medication, pending outcome.
Critical Actions
- Patients who fulfill none of the Ottawa Ankle Rule criteria do not need an ankle or foot x-ray. Those fulfilling either the foot or ankle criteria need an x-ray of the respective body part.
- Many experts would consider this score “one directional.” Because the rule is sensitive and not specific, it provides a clear guide of which patients not to x-ray if all criteria are met. However, if a patient fails the criteria, need for x-ray can be left to clinical judgment.