🦶 Ottawa Ankle & Foot Rules
Decide whether ankle/foot X-rays are needed after injury with the Ottawa rules.
Highly sensitive for clinically significant fractures.
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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
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Pain in the malleolar zone | No |
|---|---|
| Tenderness at posterior edge/tip of lateral malleolus | No |
| Tenderness at posterior edge/tip of medial malleolus | No |
| Pain in the midfoot zone | No |
| Tenderness at base of 5th metatarsal | No |
| Tenderness at the navicular | No |
| Unable to bear weight 4 steps (then & now) | No (can bear weight) |
→ImagingNo X-ray needed
- Ankle series：Not indicated
- Foot series：Not indicated
| Pain in the malleolar zone | Yes |
|---|---|
| Tenderness at posterior edge/tip of lateral malleolus | Yes |
| Tenderness at posterior edge/tip of medial malleolus | Yes |
| Pain in the midfoot zone | Yes |
| Tenderness at base of 5th metatarsal | Yes |
| Tenderness at the navicular | Yes |
| Unable to bear weight 4 steps (then & now) | Yes (cannot) |
→Imagingankle X-ray indicated + foot X-ray indicated
- Ankle series：Indicated
- Foot series：Indicated
Frequently asked questions
- What is Ottawa Ankle & Foot Rules?
- Decide whether ankle/foot X-rays are needed after injury with the Ottawa rules.
- How is Ottawa Ankle & Foot Rules calculated? What is the core formula?
- 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.
- When is Ottawa Ankle & Foot Rules used?
- Reduce unnecessary radiography in acute ankle/foot injury.
- What are the key clinical points for Ottawa Ankle & Foot Rules?
- 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.
- What are the limits and cautions when using Ottawa Ankle & Foot Rules?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- How is Ottawa Ankle & Foot Rules calculated in practice? Can you show a worked example?
- Inputs: Pain in the malleolar zone No, Tenderness at posterior edge/tip of lateral malleolus No, Tenderness at posterior edge/tip of medial malleolus No, Pain in the midfoot zone No, Tenderness at base of 5th metatarsal No, Tenderness at the navicular No, Unable to bear weight 4 steps (then & now) No (can bear weight) → Result: Imaging No X-ray needed（Ankle series: Not indicated, Foot series: Not indicated） Inputs: Pain in the malleolar zone Yes, Tenderness at posterior edge/tip of lateral malleolus Yes, Tenderness at posterior edge/tip of medial malleolus Yes, Pain in the midfoot zone Yes, Tenderness at base of 5th metatarsal Yes, Tenderness at the navicular Yes, Unable to bear weight 4 steps (then & now) Yes (cannot) → Result: Imaging ankle X-ray indicated + foot X-ray indicated（Ankle series: Indicated, Foot series: Indicated）