Ottawa Ankle Rules – When to x-ray an ankle injury? – Wilson Tang
Ankle and foot injuries are extremely common in both contact and non-contact sports. Most of these occur during moments such as landing, contact, or change of direction/agility. This may result in bone, ligament, muscle/tendon injuries or a combination of all. Once an injury has happened, it can be difficult to determine whether to continue play or if medical attention is required at the time.
It is estimated that ~85% of ankle/foot injuries present with no fractures, however many ankle/foot injuries are referred for imaging unnecessarily (Pires et al., 2014). Hence, the Ottawa Ankle Rules were developed by emergency doctors to help identify acute ankle/foot fractures that indeed require x-ray imaging.
It is reported that the Ottawa Ankle Rules are ~97% accurate in ruling OUT fractures, but far less accurate for ruling IN fractures.
Other factors to consider:
– The Ottawa Ankle Rules don’t account for other potential injuries such as ligament, tendon or muscles.
– The initial development of the Ottawa Ankle Rules did not consider utility on athletes under 18 years old.
– Other potential injuries or conditions which may occur concurrently.
Therefore, best judgement should be made when applying the Ottawa Ankle Rules and deciding on returning to play or not after initial injury.
If after using the above framework you still have any doubts, don’t be afraid to refer your player/patient on to your local physiotherapist or doctor.
References:
Pires, R., Pereira, A., Abreu-E-Silva, G., Labronici, P., Figueiredo, L., Godoy-Santos, A., & Kfuri, M. (2014). Ottawa ankle rules and subjective surgeon perception to evaluate radiograph necessity following foot and ankle sprain. Annals of Medical and Health Sciences Research, 4(3), 432–435.
Stiell I. (1996). Ottawa ankle rules. Canadian Family Physician Medecin De Famille Canadien, 42, 478–480.
