Ottawa rules for ankle and foot x-ray
🦴 BT = Bone tenderness.
🤕 Treat sprains with RICE (Rest, Ice, Compression, Elevation, + Analgesia).
📉 The Ottawa Ankle Rules reduce unnecessary X-rays by up to 25%.
📋 Ottawa Ankle Rule Criteria
| Criteria |
Indication for X-Ray |
| 🦶 Ankle X-Ray |
- 🟥 Pain in the malleolar zone AND
- 🦴 Bone tenderness at posterior edge/tip of lateral malleolus (distal 6 cm) OR
- 🦴 Bone tenderness at posterior edge/tip of medial malleolus (distal 6 cm) OR
- 🚶 Inability to bear weight immediately after injury & in ED (unable to take 4 steps unaided).
|
| 👣 Foot X-Ray |
- 🟥 Pain in the midfoot zone AND
- 🦴 Bone tenderness at base of 5th metatarsal OR
- 🦴 Bone tenderness at navicular bone OR
- 🚶 Inability to bear weight immediately after injury & in ED (unable to take 4 steps unaided).
|
ℹ️ Additional Notes
- ✅ Ottawa Ankle Rules are highly sensitive (~100%) for ankle & midfoot fractures → helps rule out fracture safely.
- ❌ Do not apply in:
- Multiple injuries, head injury, or intoxication.
- Peripheral neuropathy / reduced sensation.
- Strong suspicion of stress fracture (often subtle & not tender acutely).
- 🔎 If swelling & pain persist after 5–7 days → repeat assessment (occult fractures may later become visible).
🛠️ Management of Ankle/Foot Sprains (RICE Protocol)
- 🛑 Rest: Limit weight-bearing, crutches if required. Resume activity gradually as pain allows.
- 🧊 Ice: Apply 15–20 min every 1–2 hrs for first 48 hrs to reduce pain/swelling.
- 🩹 Compression: Elastic bandage/ankle support. Must be snug but not restrictive to circulation.
- 🦵 Elevation: Keep above heart level especially first 24–48 hrs to reduce swelling.
- 💊 Analgesia: NSAIDs or paracetamol; NSAIDs also reduce inflammation.
📤 When to Refer
- 🔧 Suspected high ankle sprain / syndesmotic injury (positive squeeze test).
- ⏳ No improvement after conservative management, or persistent instability.
- ⚠️ Neurovascular compromise OR severe functional limits beyond 2–6 weeks recovery window.
