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Ottawa Ankle Rules

The Ottawa Ankle Rules are simple guidelines developed to aid emergency physicians in deciding when to use radiography for patients with injuries to the ankle. The Ottawa Ankle Rules were developed and clinically tested to show that they led to a decrease in the use of ankle radiography, waiting times, and costs without patient dissatisfaction or missed fractures.

First, while inspecting the medial ankle, palpating along the posterior edge of the medial malleoli as well as proximally 6 cm along the tibia.  Then, palpate over the navicular bone.

Now, on the lateral ankle, again palpate along the posterior edge of the malleoli including superior 6 cm along the fibula.  Finally, palpate the base of the 5th metatarsal.

If the patient is unable to walk 4 steps and has malleoli pain and tenderness an ankle x-ray series is indicated, while inability to walk 4 steps and mid-foot pain with navicular or 5th metatarsal pain indicates need for a foot x-ray series.

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