Ottawa ankle rules

Dr Henry Knipe et al.

The Ottawa ankle rules are a clinical decision-making strategy for determining which patients require radiographic imaging for ankle and foot injuries. Proper application has high (97.5%) sensitivity and reduces the need for radiographs by ~35% 1,2,4

There are two components, assessing for ankle and midfoot fractures. A patient with traumatic ankle pain qualifies for a radiograph if 1,3:

  • point tenderness at posterior edge (of distal 6 cm) or tip lateral malleolus
  • point tenderness at posterior edge (of distal 6 cm) or tip medial malleolus
  • inability to weight bear (four steps) immediately and in emergency department

A patient with traumatic foot pain qualifies for a radiograph if 1,3:

  • point tenderness at the base of the fifth metatarsal
  • point tenderness at the navicular
  • inability to weight bear (four steps) immediately and in emergency department

The Ottawa ankle rules have been validated in children, although children need to be normally ambulating to apply the rule, and due to a lack of data the rules should applied with caution in children <6 years old 4,5

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Article information

rID: 43473
Section: Approach
Synonyms or Alternate Spellings:
  • Ottawa ankle rules (OAR)
  • Ottawa foot rules
  • Ottawa foot and ankle rules

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