🦶 Ottawa Ankle & Foot Rules
UseWhen to use: alert adults with isolated acute ankle/midfoot injury.
StrataRules are highly sensitive for clinically important fractures; negatives can spare films when applicable.
LimitsWhen not to use: intoxication, unreliable exam, major distracting inj… · Pitfall: mixing ankle vs foot zones or confusing with Ottawa knee / P… · Do not override obvious deformity or open injury.
SourceStiell IG, et al. Ann Emerg Med 1992 / 1993 (Ottawa ankle/foot rules)
This-shift next steps
After scoring: open the scene pack, peer scores, and the matching pathway. Local reference — no HIS write.
Paste the link in Slack, Teams, X, or LinkedIn — the preview image comes from this page’s Open Graph card.
Methodology · worked example, guidelines & full notes
High sensitivity, moderate specificity.
When to use
When to use: alert adults with isolated acute ankle/midfoot injury.
How it works
Ankle series if malleolar-zone pain plus malleolar bony tenderness or inability to bear weight; foot series if midfoot pain plus 5th-metatarsal/navicular tenderness or inability to bear weight.
Key points
- High sensitivity, moderate specificity.
- Weight-bearing = four steps immediately and in ED.
- Next: Ottawa knee if knee injury; analgesia and follow-up if rule-negative.
References
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Pain in the malleolar zone | No |
|---|---|
| Tenderness at posterior edge/tip of lateral malleolus | No |
| Tenderness at posterior edge/tip of medial malleolus | No |
| Pain in the midfoot zone | No |
| Tenderness at base of 5th metatarsal | No |
| Tenderness at the navicular | No |
| Unable to bear weight 4 steps (then & now) | No (can bear weight) |
→ImagingNo X-ray needed
- Ankle series：Not indicated
- Foot series：Not indicated
| Pain in the malleolar zone | Yes |
|---|---|
| Tenderness at posterior edge/tip of lateral malleolus | Yes |
| Tenderness at posterior edge/tip of medial malleolus | Yes |
| Pain in the midfoot zone | Yes |
| Tenderness at base of 5th metatarsal | Yes |
| Tenderness at the navicular | Yes |
| Unable to bear weight 4 steps (then & now) | Yes (cannot) |
→Imagingankle X-ray indicated + foot X-ray indicated
- Ankle series：Indicated
- Foot series：Indicated
Verification & sources · governance
FAQ
Frequently asked questions
- Does Ottawa Ankle & Foot Rules upload patient data? Where is it calculated?
- Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.
- How is Ottawa Ankle & Foot Rules calculated in practice? Can you show a worked example?
- Inputs: Pain in the malleolar zone No, Tenderness at posterior edge/tip of lateral malleolus No, Tenderness at posterior edge/tip of medial malleolus No, Pain in the midfoot zone No, Tenderness at base of 5th metatarsal No, Tenderness at the navicular No, Unable to bear weight 4 steps (then & now) No (can bear weight) → Result: Imaging No X-ray needed（Ankle series: Not indicated, Foot series: Not indicated） Inputs: Pain in the malleolar zone Yes, Tenderness at posterior edge/tip of lateral malleolus Yes, Tenderness at posterior edge/tip of medial malleolus Yes, Pain in the midfoot zone Yes, Tenderness at base of 5th metatarsal Yes, Tenderness at the navicular Yes, Unable to bear weight 4 steps (then & now) Yes (cannot) → Result: Imaging ankle X-ray indicated + foot X-ray indicated（Ankle series: Indicated, Foot series: Indicated）