Ottawa Ankle Rules


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According to the Ottawa Ankle Rules, ankle x-rays are neccesary only if there is pain in the malleolar zone and either:

  • The patient was unable to bear weight immediately after the injury and is still unable to bear weight for steps

  •      OR

  • There is bone tenderness at the posterior edge or tip of either the lateral or medial malleolus


  • X-rays of the foot are indicated only if there is pain in the midfoot and either:

  • The patient was unable to bear weight immediately after the injury and is still unable to bear weight for four steps.

  •      OR

  • There is bone tenderness at the navicular or the base of the fifth metatarsal.

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