Ottawa Ankle & Foot Rule
Info
Is there pain near the malleoli? Yes No
Is there pain in the midfoot? Yes No
~Major Criteria
Is there bony tenderness at the posterior edge or tip of the lateral malleolus? Yes No
Is there bony tenderness at the posterior edge or tip of the medial malleolus? Yes No
Is there bony tenderness at the base of the 5th metatarsal? Yes No
Is there bony tenderness at the navicular (mid-foot) region? Yes No
Is there an inability to weight bear both immediately following the injury and in the Emergency Department (at least 4 steps)? Yes No
R e s u l t s
~Major Criteria
 
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Info
Ottawa Ankle & Foot Rule

The Ottawa Ankle and Foot Rules are guidelines that were developed in Canada, to aid Emergency Physicians in deciding when to use radiography for patients with injuries to the ankle or foot.

These rules have been clinically tested and appear to lead to a decrease in the use of ankle & foot radiography, waiting times, and costs without patient dissatisfaction or missed fractures.

In one meta-analysis, foot and ankle fractures were missed in just 0.3% of cases using these rules and in children with ankle fractures, the rules were 100% sensitive (in 670 children). Other evaluations have shown 97% sensitivity.

Items to note

  • The foot rules are for MIDFOOT fractures only and not for distal injuries
  • These rules are for painful ankle or foot presenting within 10 days of injury

How these rules are applied:

The required item must be present PLUS at least 1 additional major criteria to indicate need for a radiograph (Xray).

The Ankle Rules are:

Required item:

  • Is there pain near the malleoli?

Major Criteria:

  • Is there bony tenderness at the posterior edge or tip of the lateral malleolus?
  • Is there bony tenderness at the posterior edge or tip of the medial malleolus?
  • Is there an inability to weight bear both immediately following the injury and in the Emergency Department (at least 4 steps)?

The Foot Rules are:

Required item:

  • Is there pain in the midfoot?

Major Criteria:

  • Is there bony tenderness at the base of the 5 th metatarsal?
  • Is there bony tenderness at the navicular (mid-foot) region?
  • Is there an inability to weight bear both immediately following the injury and in the Emergency Department (at least 4 steps)?

References:

  1. Anis AH, Stiell IG, Stewart DG, et al. Cost-effectiveness analysis of the Ottawa Ankle Rules. Ann Emerg Med 1995;26:422-8.
  2. Bachmann LM, Kolb E, Koller MT, et al. Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review. BMJ . 2003;326:417.
  3. Ebell MH. Evaluating the Patient with an Ankle or Foot Injury. Am Fam Phys . 2004;70(8):1535-6.
  4. McBride KL. Validation of the Ottawa ankle rules. Experience at a community hospital. Can Fam Physician . 1997;43:459-65.
  5. Plint AC, Bulloch B, Osmond MH, et al. Validation of the Ottawa Ankle Rules in children with ankle injuries. Acad Emerg Med . 1999;6:1005-9.
  6. Stiell IG, Wells G, Laupacis A, et al. A multicentre trial to introduce clinical decision rules for the use of radiography in acute ankle injuries. BMJ . 1995;311:594-7.
  7. Stiell IG, McKnight RD, Greenberg GH, et al. Implementation of the Ottawa Ankle Rules. JAMA . 1994;271:827-832.
  8. Stiell IG, Greenberg GH, McKnight RD, et al. Decision Rules for the Use of Radiography in Acute Ankle Injuries. JAMA 1993;269:1127-32.
  9. Stiell IG, Greenberg GH, McKnight RD, et al. A Study to Develop Clinical Decision Rules for the Use of Radiography in Acute Ankle Injuries. Ann Emerg Med . 1992;21:384-390.