Ottawa ankle and foot rules.
For healthcare professionals. Does this acute ankle or midfoot injury in an adult need an X-ray? Nothing is stored or sent.
Dr Aditya Aggarwal, MS (Ortho), PMC 45581, Aggarwal Clinic, Patiala
For clinicians and healthcare professionals. Nothing you enter is stored or sent.
Knee injury? Use the Ottawa knee rule on Knee Check
Who the rules apply to
Adults (18 or older) with an acute ankle or midfoot injury. Do not use these rules if any of these apply:
- Under 18 years old
- Intoxication
- Multiple painful injuries
- Pregnancy
- Head injury
- Reduced sensation
- Injury more than 10 days old
- Reassessment of the same injury
- Isolated skin injuries
Ottawa ankle rule
An ankle X-ray series is suggested only if there is pain in the malleolar zone and any one of the findings below.
Pain in the malleolar zone
Bone tenderness along the distal 6 cm of the posterior edge of the fibula, or the tip of the lateral malleolus
Bone tenderness along the distal 6 cm of the posterior edge of the tibia, or the tip of the medial malleolus
Unable to bear weight for 4 steps both immediately after the injury and in the emergency department
Result
Answer the questions
Start with the zone question.
Ottawa foot rule
An foot X-ray series is suggested only if there is pain in the midfoot zone and any one of the findings below.
Pain in the midfoot zone
Bone tenderness at the base of the 5th metatarsal
Bone tenderness at the navicular
Unable to bear weight for 4 steps both immediately after the injury and in the emergency department
Result
Answer the questions
Start with the zone question.
A systematic review of 27 studies found a pooled negative likelihood ratio of 0.08 for both ankle and midfoot (Bachmann et al., BMJ 2003).
Source
Citation: Rule wording as reproduced by the NSW Agency for Clinical Innovation (ECAT appendix) and the RANZCR / Ottawa guideline sheet. Original rules: Stiell IG et al. JAMA 1993;269(9):1127–32 (doi:10.1001/jama.269.9.1127, PMID 8433468); Stiell IG et al. JAMA 1994 (PMID 8114236). Pooled figure: Bachmann LM et al. BMJ 2003;326:417 (doi:10.1136/bmj.326.7386.417, PMID 12595378).
Licence: Published clinical decision rule; no licence or registration found. A decision aid, not a diagnosis; clinical judgement applies.
Questions? WhatsApp Dr Aditya on +91 84477 30708