** These rules guide you to determine whether you should get an ankle XR alone, a foot XR alone, ankle and foot XR or no XR at all.
– If a patient cannot walk 4 steps by themselves at the scene and with the provider (ER, clinic, etc), they buy themselves XR
– But if they are able to bear weight immediately at the scene AND can take 4 steps independently in a clinical setting, it doesn’t end there. You move on to a physical exam to look for bony tenderness at 4 places.
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“The are guidelines for appropriate evaluation of ankle and midfoot injuries occurring in adults age 19 or older presenting for the first time in a clinical setting.
The guidelines utilize the historical and physical findings to determine which radiographic studies, if any, are indicated.
Patients who were able to bear weight immediately following their injury and who can take 4 steps independently in a clinical setting require radiographic study only when the following criteria are met: pain is present in the malleolar zone and bony tenderness of the posterior edge or tip of either malleolus is elicited (ankle radiograph), or pain is present in the midfoot zone and bony tenderness of either the base of the fifth metatarsal or the navicular region is present.” ABFM
https://www.mdcalc.com/ottawa-ankle-rule
Reference
Am Fam Physician 2012;85(12):1170-1176.