Ankle & Foot
Bone, Fracture & Joint Pathology
Evidence: confirmed
Ottawa Ankle Rules Special Test
Orthopedic Physical Examination & Clinical Assessment Guide
What is it used for?
- Determining the need for X-rays after acute ankle injury.
How to Perform
- Palpation: Press on the posterior edge (last 6cm) of the lateral and medial malleoli.
- Palpation: Press on the base of the 5th metatarsal and the navicular bone.
- Function: Ask the patient to walk 4 steps (weight bear) immediately after injury and in the clinic.
Interpretation of Results
- Positive: Pain in specific bony areas OR inability to bear weight indicates a need for X-rays to rule out fracture.
Diagnostic Accuracy
- High Sensitivity (approaching 100%) for ruling out fractures.
Clinical Context & Limitations
The Ottawa Ankle Rules should be considered as one component of a comprehensive musculoskeletal assessment. No single special test has perfect diagnostic accuracy; thus, clinical decision-making should integrate test results with patient-reported symptoms, mechanism of injury, functional impairment, and relevant imaging.
Clinicians should be aware of potential false-positive results in patients with pain sensitisation, muscle guarding, or poor relaxation. For the Ankle & Foot region, combining the Ottawa Ankle Rules with complementary examination tests significantly improves overall diagnostic confidence.
References
- Magee, D. J. (2021). Orthopedic Physical Assessment (7th ed.). Elsevier.
