🦶 Ottawa Ankle & Foot Rules
Decide whether ankle/foot X-rays are needed after injury with the Ottawa rules.
Ottawa Ankle & Foot Rules
Pain in the malleolar zone
Tenderness at posterior edge/tip of lateral malleolus
Tenderness at posterior edge/tip of medial malleolus
Pain in the midfoot zone
Tenderness at base of 5th metatarsal
Tenderness at the navicular
Unable to bear weight 4 steps (then & now)
When to use
Reduce unnecessary radiography in acute ankle/foot injury.
How it works
Ankle series if malleolar-zone pain plus bony tenderness at either malleolus or inability to bear weight; foot series if midfoot pain plus 5th-metatarsal-base/navicular tenderness or inability to bear weight.
Key points
- Highly sensitive for clinically significant fractures.
- Apply to alert adults with recent, isolated injury.
- Inability to bear weight = 4 steps both immediately and in the ED.
References
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.