What are the Ottawa Ankle Rules and how are they used to diagnose ankle sprain?

Updated: Jan 14, 2019
  • Author: Craig C Young, MD; Chief Editor: Sherwin SW Ho, MD  more...
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Answer

The use of radiographs in patients with ankle injuries is guided by the Ottawa Ankle Rules. These rules state that an ankle radiographic series is required only if the patient has pain in the malleolar zone and any of the following 3 findings [42, 43, 44] :

  • Bone tenderness at the posterior edge or tip of the lateral malleolus (ie, the lower 6 cm of the fibula)

  • Bone tenderness at the posterior edge or tip of the medial malleolus (ie, the lower 6 cm of the tibia)

  • Inability to bear weight immediately after the injury and in the emergency department

The Ottawa Ankle Rules state that a foot radiographic series is required only if the patient has any pain in the midfoot zone and any of the following 3 findings:

  • Bone tenderness at the base of the fifth metatarsal

  • Bone tenderness at the navicular bone

  • Inability to bear weight immediately after the injury and in the emergency department

The Ottawa Ankle Rules are contingent upon the patient presenting within 10 days of the injury. Although they were not originally intended for patients younger than age 18 years, a meta-analysis of 12 studies showed that the Ottawa foot and ankle rules can be reliably used to exclude fractures in children older than age 5 years. The studies included a total of 3,130 patients and identified 671 fractures, resulting in a prevalence of 21.4%. Demonstrating a pooled sensitivity of 98.5% and a missed fracture rate of 1.2%, the report indicated that the Ottawa foot and ankle rules are useful (level 2 evidence) for excluding fractures in children. [8] Another study suggests they may be useful for children as young as 2 years. [9]


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