The Ottawa ankle rules were developed to assist clinicians in deciding whether patients with acute ankle injuries require investigation with radiographs in order to avoid unnecessary studies. Named after the hospital where they were developed, the rules are highly sensitive and have reduced the utilization of unwarranted ankle radiographs since their implementation.
An ankle x-ray series is required if there is ankle pain and any of the following:
Bone tenderness along the distal 6 cm of the posterior tibia or tip of the medial malleolus