Ottawa Ankle & Foot Rules

Determines whether a patient with acute ankle or midfoot trauma needs an ankle and/or foot x-ray series from pain location, specific bone tenderness, and inability to bear weight, to safely avoid imaging when negative.

Pain in the malleolar zone (around the ankle bones)

No Yes

Bone tenderness at the posterior edge or tip of the LATERAL malleolus (distal 6 cm of the fibula)

No Yes

Bone tenderness at the posterior edge or tip of the MEDIAL malleolus (distal 6 cm of the tibia)

No Yes

Pain in the midfoot zone

No Yes

Bone tenderness at the base of the 5th metatarsal

No Yes

Bone tenderness over the navicular bone

No Yes

Inability to bear weight (4 steps) both immediately after injury AND in the emergency department

No Yes