Determines need for ankle radiographs
Total Score
Low risk. X-ray is NOT indicated.
Disclaimer: The clinical scoring and algorithms on this platform are intended strictly for professional informational purposes. They do not constitute a definitive medical diagnosis, treatment, or clinical decision. The final judgment and responsibility lie with the treating physician.
Yasal Uyarı: Bu platformdaki klinik skorlamalar ve algoritmalar yalnızca sağlık profesyonellerini bilgilendirme amaçlıdır. Herhangi bir kesin tıbbi teşhis, tedavi veya klinik karar yerine geçemez. Nihai karar ve sorumluluk hastayı yatak başında değerlendiren hekime aittir.
The Ottawa Ankle Rules provide a highly sensitive clinical decision aid to determine if a patient with acute ankle or midfoot trauma requires radiography. By assessing bone tenderness and weight-bearing ability, it safely reduces unnecessary X-rays and speeds up ED throughput.
The 'inability to bear weight' criterion means taking 4 consecutive steps both immediately after the injury AND in the ED. Limping counts as bearing weight! Also, remember to palpate the posterior 6 cm of the malleoli, not just the lateral tip.
Stiell IG, Greenberg GH, McKnight RD, et al. Decision rules for the use of radiography in acute ankle injuries. Refinement and prospective validation. JAMA. 1993;269(9):1127-1132.
Disclaimer: The clinical scoring and algorithms on this platform are intended strictly for professional informational purposes. They do not constitute a definitive medical diagnosis, treatment, or clinical decision. The final judgment and responsibility lie with the treating physician.
Apply the Ottawa Ankle Rules to adults presenting within 10 days of acute ankle or midfoot injury. The rules apply to the malleolar zone (ankle) and midfoot zone separately — this calculator covers the ankle (malleolar) zone. A patient must have pain in the malleolar zone AND one or more criteria to require an X-ray. If pain is in the midfoot zone (navicular or base of fifth metatarsal), the Ottawa Foot Rules apply instead. Do not apply in children under 18, pregnant patients, or patients with isolated skin injuries.
Weight-bearing ability is tested in the ED — the patient must take 4 steps unaided (limping is permitted). The inability to bear weight is one of the most sensitive individual criteria. The posterior 6 cm of either malleolus is the relevant palpation zone; tenderness over the anterior fibula or lateral ligaments without malleolar tenderness does NOT trigger the rule. The Ottawa Ankle Rules have a sensitivity approaching 100% for clinically significant fractures when correctly applied, with specificities of 30–40% (meaning most imaging is negative — the value is in safely avoiding X-rays in low-risk patients).
The Ottawa Ankle Rules were not validated for open fractures, pathological fractures, or injuries older than 10 days — do not apply in these contexts. Tenderness over the Achilles tendon or peroneal tendons is NOT a criterion; only bony malleolar tenderness counts. Patients under local anaesthesia or with altered sensation (neuropathy, intoxication) cannot be reliably assessed — obtain imaging in these cases. The rules have lower sensitivity in elderly patients with osteoporosis; maintain a low threshold for imaging in this group even with a negative rule.