Ottawa ankle rules (paediatric)

Many ankle sprains do not require radiological investigations.

Ottawa ankle rules perform well in children, provided they can communicate clearly and walk normally before the injury.

Request an x-ray of the ankle if the patient has one of:

• (A) tenderness of the lateral malleolus
• (B) tenderness at the posterior aspect of the medial malleolus
• inability to bear weight both at the time of the injury and for four steps at the time of evaluation.

Request an x-ray of the foot if the patient has one of:

• (C) tenderness at the base of the 5th metatarsal
• (D) tenderness at the navicular.

All other children presenting with findings suggestive of an ankle sprain can be treated without the need for imaging.

Adapted from: Stiell IG, McKnight RD, Greenberg GH, et al. Implementation of the Ottawa Ankle Rules. JAMA 1994; 271:827.