Ottawa Ankle and Foot Rules

Clinical decision rules to determine which ankle injuries require radiography. Highly sensitive for detecting malleolar and midfoot fractures.

Ankle Pain Present *

Ankle Pain Present

Pain in the malleolar zone

Age >= 55 years *

Age >= 55 years

Bone Tenderness at Malleoli

Posterior edge or tip of either malleolus (lateral or medial)

Inability to Bear Weight (Ankle)

Unable to take 4 steps immediately after injury and in ED

Midfoot Pain Present *

Midfoot Pain Present

Pain in the midfoot zone

Bone Tenderness at Navicular

Any part of the navicular bone

Bone Tenderness at Base of 5th Metatarsal

Inability to Bear Weight (Midfoot)

Unable to take 4 steps immediately after injury and in ED

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