Screening and diagnosis

Classification and risk stratification

Perioperative care

Quality improvement

Patient education

Nonpharmacologic interventions

Therapeutic procedures

Respiratory support

Follow-up and surveillance

Specific circumstances

Preventative measures

Medical management

Surgical interventions

Inpatient care

Diagnostic procedures

Diagnostic investigations

Insufficient evidence to make a recommendation.

Strongly favor this test or intervention.

The Ottawa Ankle Rule is a clinical guideline to determine whether a patient with an ankle injury needs an X-ray to check for a possible fracture. The decision is made based on the presence of specific symptoms related to pain, tenderness, and weight-bearing ability.

Input options for the Ottawa Ankle Rule include:

- Pain in malleolar zone
- Pain in midfoot zone
- Tenderness at posterior edge or tip of lateral malleolus
- Tenderness at posterior edge or tip of medial malleolus
- Tenderness at the base of the 5th metatarsal bone
- Tenderness at navicular bone
- Inability to bear weight both immediately and in emergency department

The rule is applied by following this logic:

1. If the patient experiences pain in the malleolar zone:
   - Consider an ankle X-ray if there is also:
     - Tenderness at the posterior edge or tip of the lateral malleolus, or
     - Tenderness at the posterior edge or tip of the medial malleolus, or
     - Inability to bear weight both immediately and in the emergency department. 

2. Alternatively, if the patient reports pain in the midfoot zone:
   - Consider an ankle X-ray if there is also:
     - Tenderness at the base of the 5th metatarsal bone, or
     - Tenderness at the navicular bone, or
     - Inability to bear weight both immediately and in the emergency department.

If none of these criteria apply, then an ankle X-ray is not necessary. By using the Ottawa Ankle Rule, clinicians can effectively minimize unnecessary radiographic imaging, reducing both patient exposure to radiation and overall healthcare costs, while ensuring an accurate assessment based on the individual's symptoms.

The Ottawa Ankle Rule is a clinical tool used primarily in emergency medicine to determine the need for radiographic imaging in patients with ankle and midfoot injuries. It is designed to rule out fractures in these areas and thus reduce unnecessary X-rays. The rule applies to patients who have ankle or midfoot pain or tenderness and are unable to bear weight both immediately after the injury and in the emergency department. The Ottawa Ankle Rule is not applicable to patients who are under the age of 18, have other distracting painful injuries, are intoxicated, have diminished sensation in the lower extremities, or are unable to understand the instructions or assessment due to language barriers or cognitive impairment.

Ankle fracture

Background

Overview

Guidelines

Key sources