Ottawa ankle rules calculator

Ottawa Ankle Rules

Ottawa Ankle Rule

Criteria	No (0)	Yes (+1)
Ankle X-ray is required if there is pain in the malleolar zone AND any of the following:
Bone tenderness along distal 6 cm of posterior edge of tibia or tip of medial malleolus	1
Bone tenderness along distal 6 cm of posterior edge of fibula or tip of lateral malleolus	1
Inability to bear weight both immediately and in the ED (4 steps)	1
Foot X-ray is required if there is pain in the midfoot zone AND any of the following:
Bone tenderness at the base of the 5th metatarsal	1
Bone tenderness at the navicular	1
Inability to bear weight both immediately and in the ED (4 steps)	1
Positive Criteria	/ 6

Interpretation
Score = 0	No X-ray needed — Sensitivity 96.4–99.6% for clinically significant fractures.
Score ≥ 1	X-ray recommended — Ankle and/or foot x-ray indicated based on positive criteria location.

References
Stiell IG et al. A study to develop clinical decision rules for radiography in acute ankle injuries. Ann Emerg Med. 1992;21:384-390. PMID 1554175. Stiell IG et al. Decision rules for radiography in acute ankle injuries: refinement and prospective validation. JAMA. 1993;269:1127-1132. PMID 8433468.