Ottawa Ankle Rule
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- If ankle pain is present and there is tenderness over the posterior 6 cm or tip of the posterior or lateral malleolus, then an ankle-ray is indicated.
- If midfoot pain is present and there is tenderness over the navicular or the base of the fifth metatarsal, then a foot-xray is present.
- 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.
- RICE plan (Rest, Ice, Compression, Elevation).
- Splinting/crutches and pain medication - pending outcome.
Patients who fulfill none of the Ottawa Ankle Rule criteria do not need an ankle or foot x-ray. Those that fulfill 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.