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Ottawa knee, ankle and foot rules

The Ottawa knee, ankle and foot rules are a guideline for doctors to aid them in deciding if a patient with foot or ankle pain should be offered X-rays to diagnose a possible bone fracture.

Ottawa ankle and foot rules



An ankle x-ray is required only if there is any pain in malleolar zone and any of these findings:

  • bone tenderness at A
  • bone tenderness at B
  • inability to weight bear both immediately and in the casualty department.

A foot x-ray is required if there is any pain in the midfoot zone and any of these findings:

  • bone tenderness at C
  • bone tenderness at D
  • inability to weight bear both immediately and in the casualty department.

Ottawa knee rules

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).

Ottawa knee, ankle and foot rules

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