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.


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


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


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


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.

Continued Learning…

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Continued Reading…


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