An Ottawa ankle rule guides clinical decision-making for ankle radiographs in trauma. According to this rule, radiographs are indicated if there is bone tenderness at the:

• A Any point on the dorsum of the foot regardless of the ability to weight-bear
• B Achilles tendon insertion only
• C Anterior talofibular ligament in the anterolateral ankle
• D Medial or lateral malleolus, or inability to weight-bear 4 steps immediately after injury and in the emergency department ✓

Explanation

The Ottawa ankle rules (97–99% sensitivity for fractures) state that ankle X-rays are required if there is malleolar zone pain AND either: (1) bone tenderness at the posterior edge/tip of either malleolus, OR (2) inability to bear weight (4 steps) both immediately after the injury and in the ED. The Ottawa foot rules (for midfoot) require X-rays if there is bone tenderness at the navicular or base of the 5th metatarsal. These rules safely reduce unnecessary radiographs by 30–40%.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.