Ottawa ankle rules

X-ray decision rule for acute ankle/midfoot injuries.

Last reviewed January 6, 2026

Pain zone

Malleolar zoneMidfoot zoneBoth zones

Bone tenderness at posterior edge/tip of lateral malleolus

NoYes

Bone tenderness at posterior edge/tip of medial malleolus

NoYes

Bone tenderness at base of 5th metatarsal

NoYes

Bone tenderness at navicular

NoYes

Unable to bear weight for 4 steps

NoYes

0 of 6 answered

Result

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Ottawa Ankle Rules refinement and validation (Stiell et al., 1993) (opens in a new tab)

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