Purpose: The Ottawa Ankle Rules were developed in order to determine the need for radiographs after acute ankle injury secondary to the risk of fracture.

Rule:

Pain in malleolar or midfoot area and Either:
1. Inability to bear weight immediately after injury AND in the ED (taking 4 steps)

OR

2. Bone tenderness at the posterior edge of tibia or fibula or tip of medial or lateral malleolus
3. Bone tenderness at the navicular or proximal base of 5th metatarsal

Interpretation:

Region Sensitivity Specificity +LR -LR
Ankle 0.99 0.35 1.53 0.02
Midfoot 0.99 0.42 1.72 0.02
Ankle & Midfoot 0.97 0.35 1.48 0.09

Research:

1. Beckenkamp PR, Lin C-WC, Macaskill P, Michaleff ZA, Maher CG, Moseley AM. Diagnostic accuracy of the Ottawa Ankle and Midfoot Rules: a systematic review with meta-analysis. British Journal of Sports Medicine. 2017; 51(6): 504-510. doi:10.1136/bjsports-2016-096858.

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