Ottawa Ankle and Foot Rules

The Ottawa ankle and foot rules give evidence-based advice on who to x-ray.

These state that, for injuries with an inversion mechanism, foot X-rays are only required if there is pain in the midfoot zone and there is either:

  • Bone tenderness at C (the base of the 5th MT), or
  • Bone tenderness at D (the navicular), or
  • Inability to weight bear (four consecutive steps) both immediately and in the ED

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