• Rationale and Comments

    Both children and adults commonly present to health care settings in outpatient clinics, urgent care clinics, and hospital emergency rooms with ankle and foot injuries. Multiple randomized controlled studies and meta-analyses have shown the high sensitivity of the Ottawa Ankle Rules to rule out fractures when criteria are not met, and thus avoid the need for imaging in the acute setting. Unnecessary imaging increases health care costs, patient wait times, and radiation exposure. It should be noted that there is much less data for application of the Ottawa Ankle Rules for children under the age of six years, due to fewer ankle and midfoot injuries in this patient population, as well as difficulty of children in this age group to walk independently.

    Sponsoring Organizations

    • American Medical Society for Sports Medicine


    • Systematic review


    • Emergency medicine
    • Orthopedic


    • Beckenkamp PR, Lin CC, Macaskill P, et al. Diagnostic accuracy of the Ottawa Ankle and Midfoot Rules: a systematic review with meta-analysis. Br J Sports Med. 2017;51(6):504-510.
    • Can U, Ruckert R, Held U, et al. Safety and efficiency of the Ottawa Ankle Rule in a Swiss population with ankle sprains. Swiss Med Wkly. 2008;138(19-20):292-296.
    • Dowling S, Spooner CH, Liang Y, et al. Accuracy of Ottawa Ankle Rules to exclude fractures of the ankle and midfoot in children: a meta-analysis. Acad Emerg Med. 2009;16(4):277-287.
    • Stiell IG, Greenberg GH, McKnight RD, et al. A study to develop clinical decision rules for the use of radiography in acute ankle injuries. Ann Emerg Med. 1992;21(4):384-390.
    • Plint AC, Bulloch B, Osmond MH, et al. Validation of the Ottawa Ankle Rules in children with ankle injuries. Acad Emerg Med. 1999;6(10):1005-1009.