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 |
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
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:
Major Criteria:
The Foot Rules are:
Required item:
Major Criteria:
References: