Ottawa Ankle Rules

Decides whether an ankle X-ray is needed after acute ankle injury.

For healthcare professionals.These calculate a score or a measurement from values you enter. They do not diagnose, and they are no substitute for clinical judgement. If you are a patient, discuss any result with your own doctor rather than acting on it.

Pain in the malleolar zone (required for the rule to apply)

Bone tenderness at the posterior edge or tip of the lateral malleolus (distal 6 cm)

Bone tenderness at the posterior edge or tip of the medial malleolus (distal 6 cm)

Unable to bear weight both immediately after injury and in the ED (4 steps)

Result

X-ray Not Indicated (by Ottawa Ankle)

No pain in the malleolar zone — the ankle component of the rule doesn't apply; consider the Ottawa Foot Rules separately if midfoot pain is present.

Source

Stiell IG, Greenberg GH, McKnight RD, et al. Decision rules for the use of radiography in acute ankle injuries. JAMA. 1993;269(9):1127-1132.

Shown for reference and checked against the source above. Confirm against current guidance before acting on it, and use your own clinical judgement.

These live inside Kyorit MD too

Specialists get the full set, including dosing and infusion calculators, alongside virtual chambers and board consultations.

Open Kyorit MD