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I Rolled my Ankle, is it broken?
As a physiotherapist, it's important to be able to identify whether or not a patient or player, who may have rolled or sprained their ankle, has a fracture or not. One effective way to do this is by using the Ottawa Ankle Rules.
The Ottawa Ankle Rules are a set of guidelines, determined in the 1990’s by a group of Canadian researchers and healthcare professionals led by Dr. Ian Stiell. They help to determine whether or not an ankle injury requires an X-ray to rule out a fracture. These rules help healthcare professionals like physiotherapists determine whether a patient needs imaging and or not, helping to efficiently diagnose and provide early intervention to a broken bone and just as importantly, reduce unnecessary radiation exposure and healthcare costs.
The Ottawa Ankle Rules consist of the following criteria:
- Bony tenderness along the 6cm of posterior edge of or tip the lateral (the outside of the ankle bone, fibula)
- Bony tenderness along the 6cm of posterior edge of or tip the medial malleolus (the inside ankle bone, tibia)
- Bony tenderness at the base of 5th metatarsal (outside of the foot inline with the little toe)
- Bony tenderness at the navicular (ankle joint line - mid-foot, on the inside - top aspect)
- Inability to bear weight for four steps immediately after the injury and at the time of assessment.
If a patient meets any of these criteria, an X-ray is recommended to rule out a fracture. If the patient does not meet any of these criteria, an X-ray is generally not needed.
When Not to Use Ottawa Ankle Rules:
It's important to note that the Ottawa Ankle Rules are not appropriate for use with children under the age of 18, pregnant women, or patients with a history of ankle fractures or surgeries. In these cases, a more comprehensive assessment may be necessary.
What to do next?
If you suspect that a patient may have a fractured ankle, it's important to refer them to a medical doctor or emergency department for further evaluation and treatment. As a physiotherapist, our role is to assess and treat musculoskeletal injuries, but it's important to know when to refer patients for further care.
In conclusion, the Ottawa Ankle Rules are a valuable tool for physiotherapists in determining whether or not a patient with an ankle injury requires an X-ray to rule out a fracture. By following these guidelines, physiotherapists can help reduce unnecessary radiation exposure and healthcare costs, while ensuring that patients receive appropriate care for their injuries.