ToolsCalculators
Ottawa ankle and foot rules
Ottawa ankle and 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 (immediately and in ED)
ResultNo radiograph needed
No criteria met — clinically significant fracture is very unlikely.
- Ankle radiograph
- Not indicated
- Foot radiograph
- Not indicated
When to use
- Excluding fracture in acute ankle or midfoot injury to reduce radiography.
Formula
Ankle x-ray if malleolar pain AND (lateral OR medial malleolar tenderness OR inability to bear weight). Foot x-ray if midfoot pain AND (5th-metatarsal-base OR navicular tenderness OR inability to bear weight).
Pearls and pitfalls
- Validated for patients over 18; use caution and clinical judgement in young children and the intoxicated.