Ankle and foot injuries are common reasons for emergency department visits. When patients come to the emergency department with these injuries, they usually want an X-ray to make sure nothing is broken. Too many ankle and foot X-rays are ordered. Many times the physician can reliably determine, without an x-ray, but by a good patient history and physical exam, if a broken bone may be present.
The best studies on how to decide which ankle injuries may have a broken bone, and hence need an X-ray, were done by Dr. Stiell and others in Ottawa, Canada. Their well-known guidelines are called the “Ottawa Ankle Rules.” They are simple, and you can use them to help decide if you need to be seen for an ankle or foot injury. It’s helpful to know that the lateral malleolus is the bony bump on the outside of the ankle, and the medial malleolus is the bony bump on the inside.