The Ottawa Ankle Rules

“I just sprained my ankle. Should I just let it heal on it’s own or should I go to the ER?”

The biggest question that most people have after they sprain their ankle is with what to do after.  How can you tell if it’s a more serious injury that may require medical help?  Is there a way you can tell if you need X-rays on your own?
Health practitioners use a system called the Ottowa Ankle rules (initially developed in Canada to help save the costs of taking unnecessary X-rays for every person coming in with a foot sprain.  Many ankle sprains do not need surgical intervention or even a protective boot. But without an X-ray, how can you know?

#1 – Can you bear weight? Meaning, can you stand on that foot and take four steps without pain.  If you can’t without pain, you should get an X-ray.

#2) – Do you have tenderness at the medial (inside) or lateral (outside) malleolus (tips or posterior edge) or 6 cm up from your ankle bone? These are the bony parts of your ankle that stick out on either side of your ankle.  If it feels tender at either of these spots, get an X-ray.
#3) – Do you have tenderness at your navicular (bone on the inside of the foot above your arch) or base of your 5th metatarsal (bone at outside middle of foot)? On the outside of the foot, you can find the 5th metatarsal and it’s the bump right in the middle (see the diagram).  These bones are important for maintaining the proper foot shape when walking.  The base of the 5th metatarsal also does not heal as well and may need surgical intervention if it’s broken, so it’s important to check if it is injured there.  If you have tenderness at either of these points, get an X-ray.
What this means

The Ottawa Ankle rules has been a great sensitivity test, meaning that if you do have a fracture that requires more serious medical attention, it will almost always come out positive.  However, because of this, there is also a minor chance of a false positive. This means that you may be positive on the test, but you might still check out to be ok after you get your X-rays.  (It’s better to be safer and have a more sensitive test).  Overall, hospitals and emergency rooms have been able to save everyone a lot of time and money from doing unnecessary X-rays while still being able to make sure that those who may need them are still getting X-rays.

Lastly, if for some reason you are still having pain 5-7 days later with minimal improvement, go see a health practitioner just in case.
Next post:  Chronic Complaints After Ankle Sprains and What To Do About It