Ottawa Ankle Rules

Ottawa Ankle Rules is an assessment tool for decision-making regarding ankle and foot injuries. It helps determine the need for imaging. Download this PDF now!

Ericka Pingol
Ericka Pingol
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What Is An Ottawa Ankle Rules?

Ankle and Foot injuries are commonly encountered in Emergency Departments. It is so common that in a day, there are 25,000 reports of ankle sprains. With this fact, radiography or imaging requests enormously increase as well. Apparently, only a small percentage of the imaging done would show fractures.

became the solution to decrease unnecessary requests for imaging or radiography. Not only because it contributes to the hospital costs, but some injuries also would not really need to be ordered for an x-ray. In order to mitigate these opportunities, a group of doctors in the Emergency Department in Ottawa, Canada, pioneered the list of rules in 1992.

It is evidently found to be accurate in assessing whether an injury is an ankle or foot fracture; that is why it is called a decision-making assessment. Ottawa Ankle Rules directs the attending physician on whether to request imaging for the patient.

Printable Ottawa Ankle Rules

Download this Ottawa Ankle Rules and make more informed clinical decisions regarding ankle injuries.

How To Use This Ottawa Ankle Rules

Step one. Download and Print the PDF. 

You can either choose if you will administer the assessment through paper or digital completion. Print the template if it will be administered in person, though it is also an option to fill out the assessment through a digital device in the PDF is made editable. 

Step two. Get the patient’s information.

Gather the patient’s personal information. It is important to get these as part of the rules to know the age of the patient as there’s a recommendation to which age group it can be administered. 

Step three. Be reminded of the recommendations. 

Make sure to read the recommendation in applying the Ottawa Ankle Rules accurately. If these were thoroughly followed, it would be highly accurate in deciding whether to request radiography. 

Step four. Go through the rules and examine the patients’ sprain. 

Check the Ottawa Ankle Rules Sample one by one and examine the patient's condition. Pay attention to small details and also the background of the injury. A thorough interview and examination are critical. 

Step five. Go through the results and relay the decision. 

Once the examination is through, properly relay the decision on whether to order imaging. Store the document properly with the consent of your patient. 

Ottawa Ankle Rules Example (Sample)

You will need good anatomy and physiology knowledge to administer this decision-making tool. You can see how the diagram is labeled in different parts of the feet. The Ottawa Ankle Rules Template should be filled out with the utmost keenness to detail.

Download this Ottawa Ankle Rules Example (Sample) here:

Ottawa Ankle Rules Example (Sample)

When Would You Typically Use An Ottawa Ankle Test?

When patients are rushed to the Emergency room due to an Ankle or Foot Injury, Physicians will conduct an examination. By the end of the examination, medical practitioners will need to decide on the tests that need to be done for a thorough treatment plan. This is when Ottawa Ankle Test is needed.

Use the Ottawa Ankle Test in these instances: 

Deciding whether the patient’s Ankle or Foot Injury needs a radiograph. 

Doctors or medical practitioners have to provide their decision after an initial examination of the patient. One of the reasons why these rules were created was to avoid getting a Radiography and later finding out the expected results. 

Numerous Radiography Orders. 

One of the busiest departments in the hospital is the Radiology Department. The creators of these rules found that most of the results of the numerous radiography orders for Ankle and Middle foot injuries are normal. To save healthcare costs and to decrease unnecessary imaging requests, it is best to use the Ottawa Ankle Test Assessment first. 

Ruling out fractures. 

Physiotherapists are usually the first to attend to these cases in the Emergency Department. This test should be used to determine whether the injury is a fracture or not. If the criteria were failed, then it is faster to recommend a decision if the condition is identified as a fracture. 

Who Can Use these Printable Ottawa Ankle Rules?

This clinical decision-making assessment tool is generally helpful to medical practitioners. It is recommended to those who are knowledgeable in Physical Therapy or Human Anatomy. 

Mainly, here are the people who can use this test: 

  • Physicians. Physicians are one of the first contacts of the patients in the Emergency Department. Part of their examination was to see the injury and rule out fractures. This assessment tool would aid them in deciding on the tests that should be performed. 
  • Physical Therapists or Physiotherapists. Physiotherapists are knowledgeable in Ankle or Middle foot injuries. This can be useful to them in deciding whether the patient needs imaging. 
  • Radiologists. This can be used or recommended by radiologists to control the spike of radiography orders for ankle or middle foot injuries. 
  • Nurses. It is helpful for the nurses when aiding the attending physician in identifying the recommended treatment plan for the patient’s injury. Nurses can administer the test, given that they are well-trained in handling injury cases. 
  • Chiropractors. Consultations with chiropractors are sophisticated. Ottawa Ankle Rules Assessment can help in referring other specialists in the concern of the client or if imaging will be needed before they conduct the adjustment session. 

Benefits Of Free Ottawa Ankle Rules

Decision Guide

One of the primary purposes of the Ottawa Ankle Rules Assessment is to help physicians decide whether a patient should get a radiograph. It also directs the physicians to refer the patient to physical therapists for a better treatment plan. 


The creators of this Ottawa Ankles Rules aimed to decrease the unnecessary imaging order for ankle or middle foot injuries, as most of the results would show typical signs. Most of these injuries are soft tissues, and X-rays won’t be able to identify ligament injuries. This saves additional healthcare costs for the patient and the radiology department. 


Since the whole purpose of creating this screening is to remove the unnecessary, the care that the patient needs becomes more seamless and smoother because of the proper administration of this assessment tool. 

Improves Patient Flow 

This assessment tool helps healthcare practitioners have a more straightforward path with the patient’s treatment plan. Instead of a longer wait time because of unnecessary requests for imaging, Ottawa Ankle Rules ease the flow in the Emergency Department. It gives more time to attend to more patients and lessens the wait time. 

Saves time 

With this screening tool, the medical specialist and the patient save time by skipping some of the examination flow and advising the treatment plan. Since this guide helps healthcare practitioners decide the next step, it clears the process and makes the treatment more efficient.

Why Use Carepatron For Ottawa Ankle Rules Software?

Sprains and fractures can have very similar symptoms and it is critical to know the difference between them. Physical Therapists and other attending examiners, especially in the Emergency Department, ought to have an excellent guide with their decisions regarding the examination. Carepatron comes into the picture by making this examination easier and more efficient.

Carepatron cares about decreasing the manual work for practitioners. Using Carepatron’s template for Ottawa Ankle Rules help in increasing efficiency by attending to the patients more. As healthcare practitioners, the focus on the patient is much preferable to doing the load of administrative work. 

So what are you waiting for? Don’t keep your patients waiting in line. Join Carepatron for free today! 

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What is the importance of the Ottawa ankle rules?
What is the importance of the Ottawa ankle rules?

Commonly asked questions

What is the importance of the Ottawa ankle rules?

Ottawa ankle rules help in the decision-making process of doctors in deciding whether the patient’s ankle or middle foot injury would need imaging. It helps improve patient flow and decrease unnecessary radiographs.

Do Ottawa ankle rules help the examiner determine if an x-ray is required?

Through this test, examiners will be able to determine whether the Ankle or Middle foot injury indicates an X-ray. Examiners have to check the location of the pain and they would be able to tell when a patient’s injury is actually a fracture or sprain.

What are the parts of Ottawa ankle rules?

The Ottawa ankle rules assessment has 5 components for screening:

A. Tenderness of the bone along distal 6 cm of posterior edge of fibula or tip of lateral malleolus

B. Tenderness of the bone  along distal 6 cm of posterior edge of tibia/tip of medial malleolus

C. Tenderness of the bone  at the base of 5th metatarsal

D. Tenderness of the bone at the navicular

E. Inability to bear weight both immediately after injury and for 4 steps during the initial evaluation

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