Ottawa Ankle Rules
Ottawa Ankle and Foot Rules (derived Stiell 1992; these are the refined rules of Stiell 1993): ankle x-ray if malleolar-zone pain plus posterior-malleolus tenderness or inability to bear weight.
Open the calculator → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- Pain in malleolar zone
- Yes
- Lateral malleolus tenderness
- Yes
- Medial malleolus tenderness
- No
- Ankle: cannot bear weight 4 steps
- Yes
- Pain in midfoot zone
- No
- Base of 5th metatarsal tenderness
- No
- Navicular tenderness
- No
- Foot: cannot bear weight 4 steps
- No
Result: Ankle x-ray indicated per the refined Ottawa rules (Stiell 1993).
The tool opens with these values already filled in. Replace them with your own.
What the result means
- no criteria
- No imaging indicated by the refined Ottawa Ankle Rules (Stiell 1993).
- ankle criteria met
- Ankle x-ray indicated per the refined Ottawa rules (Stiell 1993).
- foot criteria met
- Foot x-ray indicated per the refined Ottawa rules (Stiell 1993).
What you enter
- Pain in malleolar zone
- Lateral malleolus tenderness (distal 6 cm)
- Medial malleolus tenderness (distal 6 cm)
- Ankle: cannot bear weight 4 steps
- Pain in midfoot zone
- Base of 5th metatarsal tenderness
- Navicular tenderness
- Foot: cannot bear weight 4 steps
How this is calculated
Citation
Stiell IG, et al. Decision rules for the use of radiography in acute ankle injuries: refinement and prospective validation. JAMA. 1993;269(9):1127-1132 (the refined rules scored here). Derivation: Stiell IG, et al. Ann Emerg Med. 1992;21(4):384-390. Read the sources: Stiell 1993 ↗, Stiell 1992 ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.