Ottawa rules for ankle and foot x-ray

BT = Bone tenderness. Treat sprains with RICE (rest, ice compression, elevation and analgesia). If Ottawa rules do not indicate the need to an X-ray then diagnose a sprain. The rules reduce unnecessary x-rays by 25%

Ankle X-ray indicated if malleolar pain and

• BT at the posterior tip of lateral malleolus
• BT at the posterior tip of medial malleolus
• Unable to weight bear now and at time of injury
• Foot X-ray indicated if the pain in midfoot and
• BT at 5th Metatarsal
• BT at the navicular
• Unable to weight bear now and at time of injury

A knee x-ray is only required for knee injury patients with any of these findings:

• age 55 or over
• isolated tenderness of the patella (no bone tenderness of the knee other than the patella)
• tenderness at the head of the fibula
• inability to flex to 90 degrees
• inability to weight bear both immediately and in the casualty department (4 steps - unable to
• transfer weight twice onto each lower limb regardless of limping).