Radiographic Examination of the Ankle Bones
Ottawa ankle rules
After performing a history and physical examination, a decision must be made as to whether a radiograph should be obtained. The Ottawa Ankle Rules (OAR) provide a sensitive clinical decision rule for deciding when to obtain a radiograph. By selecting only those patients at risk for ankle fracture, the physician can avoid performing unnecessary radiographs.
The OAR state that an ankle radiograph series is only required when:
- The patient is unable to bear weight (4 steps) both at the time of injury and at the time of evaluation OR
- There is bone tenderness at the posterior edge of the distal 6cm or tip of the lateral or medial malleoli.
Furthermore, a foot radiograph series is required only when:
- The patient is unable to bear weight (4 steps) both at the time of injury and at the time of evaluation OR
- There is bone tenderness at the base of the fifth metatarsal or at the navicular bone.