Ottawa Ankle Rule

Case: 32 year old biker hit by slow moving car. Walking with limp and pain at L ankle/foot.

Tapa: The often referred to Ottawa Ankle/Foot Rule can help guide clinical decision making on whether or not imaging is needed.

Ottawa Ankle Rule:

Pain in malleolar zone and (any of the following)

• bone tenderness along distal 6 cm of posterior tibia
• bone tenderness along distal 6 cm of posterior fibula
• Cannot weight bear for 4 steps in Emergency Department

Ottawa Foot Rule:

Pain in midfoot and (any of the following)

• bone tenderness at base of 5th metatarsal
• bone tenderness at navicular bone
• Cananot weight bear for 4 steps in Emergency Department

Miscellaneous notes:

• Ottawa Ankle/Foot Rule is far more sensitive than specific. Therefore, if patient does not fit any criteria in Ottawa Ankle/Foot Rule, they likely do not need an x-ray
• The rule cannot be applied to pregnant women, children <>
• It is also worthwhile to palpate the proximal fibula after ankle injury, checking for a Maisonneuve fracture, and to palpate between the 1st and 2nd MTP checking for a Lisfranc Fracture/Dislocation.
• In 5th metatarsal injuries it is important to recognize the difference between a Jones and Pseudo-Jones fracture, (the former being > 1.5 cm), as this distinction will change the course of management.