Which criterion is NOT part of the Ottawa Ankle Rules for obtaining ankle radiographs after an acute injury?

Which criterion is NOT part of the Ottawa Ankle Rules for obtaining ankle radiographs after an acute injury?

• A. Tenderness at posterior edge or tip of distal tibia or distal fibula.
• B. Tenderness at the malleolar zone.
• C. Inability to bear weight for four steps.
• D. Painful sprain of the midfoot.

Answer: (D)

Ottawa Ankle Rules tell us when an ankle X-ray is needed after an acute injury by focusing on two things: bone tenderness around the ankle joint (the malleoli) and the ability to bear weight. Tenderness at the posterior edge or tip of the distal tibia or distal fibula directly maps to the malleolar tenderness criterion, and tenderness in the malleolar zone falls under the same rule. Inability to bear weight for four steps is another explicit criterion.

Painful sprain of the midfoot, however, isn’t part of the ankle rules. Midfoot concerns are covered by the Ottawa Foot Rules, which consider tenderness at the navicular or the base of the fifth metatarsal or an inability to bear weight. So midfoot pain alone doesn’t meet the ankle-rule criteria for radiographs.