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Ottawa Ankle and Foot Rules

Records the ankle and midfoot Ottawa Rule criteria separately. The result does not diagnose a fracture, and absent criteria do not guarantee absence of injury.

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Check the population, units and version. The result shows the formula or classification; it does not make an automatic treatment decision.

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Method · Limits of application

Stiell 1993; ankle and midfoot criteria

Shows positive criteria by region. Does not declare that a fracture is absent or order or waive radiography; eligibility assessment and clinical decision-making remain necessary.

Required fields: 0/8 completed

Complete all required fields. Optional fields are marked.

Pain in the malleolar region? required

Pain in the midfoot region? required

Tenderness at the posterior edge or tip of the lateral malleolus (distal 6 cm) required

Tenderness at the posterior edge or tip of the medial malleolus (distal 6 cm) required

Tenderness at the base of the fifth metatarsal required

Tenderness over the navicular required

Unable to take 4 steps (even limping) immediately after the trauma and during assessment required

Adult with closed ankle/foot injury ≤ 10 days ago; reliable examination; no pregnancy, isolated skin injury or return for the same injury; eligibility checked? required

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Conditions of use

Check the conditions of application before calculating. The result presents the documented formula or criteria; it does not establish a diagnosis or prescription.

Scope of this implementation

Shows positive criteria by region. Does not declare that a fracture is absent or order or waive radiography; eligibility assessment and clinical decision-making remain necessary.

Parameters in this edition

Pain in the malleolar region?
Pain in the midfoot region?
Tenderness at the posterior edge or tip of the lateral malleolus (distal 6 cm)
Tenderness at the posterior edge or tip of the medial malleolus (distal 6 cm)
Tenderness at the base of the fifth metatarsal
Tenderness over the navicular
Unable to take 4 steps (even limping) immediately after the trauma and during assessment
Adult with closed ankle/foot injury ≤ 10 days ago; reliable examination; no pregnancy, isolated skin injury or return for the same injury; eligibility checked?

Sources and documentation

Method version

Stiell 1993; ankle and midfoot criteria

Formula and criteria

Ankle criterion = malleolar pain AND (malleolar bone tenderness OR inability to take four steps at both time points). Foot criterion = midfoot pain AND (fifth metatarsal base OR navicular tenderness OR inability to take four steps).

Population and limitations

Shows positive criteria by region. Does not declare that a fracture is absent or order or waive radiography; eligibility assessment and clinical decision-making remain necessary.

Synthetic cases checked (5)

Synthetic cases for checking the implementation, with no patient data.

Case 1

reference-001

Inputs

Pain in the malleolar region?: Yes
Pain in the midfoot region?: No
Tenderness at the posterior edge or tip of the lateral malleolus (distal 6 cm): Yes
Tenderness at the posterior edge or tip of the medial malleolus (distal 6 cm): No
Tenderness at the base of the fifth metatarsal: No
Tenderness over the navicular: No
Unable to take 4 steps (even limping) immediately after the trauma and during assessment: No
Adult with closed ankle/foot injury ≤ 10 days ago; reliable examination; no pregnancy, isolated skin injury or return for the same injury; eligibility checked?: Yes

{
  "dor_tornozelo": "1",
  "dor_pe": "0",
  "mal_lat": true,
  "mal_med": false,
  "base5": false,
  "navic": false,
  "carga": false,
  "contexto": "1"
}

Expected result

{
  "tornozelo": 1,
  "pe": 0
}

Actual result

{
  "tornozelo": 1,
  "pe": 0
}

Case 2

reference-002

Inputs

Pain in the malleolar region?: No
Pain in the midfoot region?: No
Tenderness at the posterior edge or tip of the lateral malleolus (distal 6 cm): Yes
Tenderness at the posterior edge or tip of the medial malleolus (distal 6 cm): No
Tenderness at the base of the fifth metatarsal: No
Tenderness over the navicular: No
Unable to take 4 steps (even limping) immediately after the trauma and during assessment: No
Adult with closed ankle/foot injury ≤ 10 days ago; reliable examination; no pregnancy, isolated skin injury or return for the same injury; eligibility checked?: Yes

{
  "dor_tornozelo": "0",
  "dor_pe": "0",
  "mal_lat": true,
  "mal_med": false,
  "base5": false,
  "navic": false,
  "carga": false,
  "contexto": "1"
}

Expected result

{
  "tornozelo": 0,
  "pe": 0
}

Actual result

{
  "tornozelo": 0,
  "pe": 0
}

Case 3

reference-003

Inputs

Pain in the malleolar region?: No
Pain in the midfoot region?: Yes
Tenderness at the posterior edge or tip of the lateral malleolus (distal 6 cm): No
Tenderness at the posterior edge or tip of the medial malleolus (distal 6 cm): No
Tenderness at the base of the fifth metatarsal: No
Tenderness over the navicular: Yes
Unable to take 4 steps (even limping) immediately after the trauma and during assessment: No
Adult with closed ankle/foot injury ≤ 10 days ago; reliable examination; no pregnancy, isolated skin injury or return for the same injury; eligibility checked?: Yes

{
  "dor_tornozelo": "0",
  "dor_pe": "1",
  "mal_lat": false,
  "mal_med": false,
  "base5": false,
  "navic": true,
  "carga": false,
  "contexto": "1"
}

Expected result

{
  "tornozelo": 0,
  "pe": 1
}

Actual result

{
  "tornozelo": 0,
  "pe": 1
}

Case 4

reference-004

Inputs

Pain in the malleolar region?: Yes
Pain in the midfoot region?: Yes
Tenderness at the posterior edge or tip of the lateral malleolus (distal 6 cm): No
Tenderness at the posterior edge or tip of the medial malleolus (distal 6 cm): No
Tenderness at the base of the fifth metatarsal: No
Tenderness over the navicular: No
Unable to take 4 steps (even limping) immediately after the trauma and during assessment: Yes
Adult with closed ankle/foot injury ≤ 10 days ago; reliable examination; no pregnancy, isolated skin injury or return for the same injury; eligibility checked?: Yes

{
  "dor_tornozelo": "1",
  "dor_pe": "1",
  "mal_lat": false,
  "mal_med": false,
  "base5": false,
  "navic": false,
  "carga": true,
  "contexto": "1"
}

Expected result

{
  "tornozelo": 1,
  "pe": 1
}

Actual result

{
  "tornozelo": 1,
  "pe": 1
}

Case 5

reference-005

Inputs

Pain in the malleolar region?: Yes
Pain in the midfoot region?: No
Tenderness at the posterior edge or tip of the lateral malleolus (distal 6 cm): No
Tenderness at the posterior edge or tip of the medial malleolus (distal 6 cm): No
Tenderness at the base of the fifth metatarsal: No
Tenderness over the navicular: No
Unable to take 4 steps (even limping) immediately after the trauma and during assessment: No
Adult with closed ankle/foot injury ≤ 10 days ago; reliable examination; no pregnancy, isolated skin injury or return for the same injury; eligibility checked?: Yes

{
  "dor_tornozelo": "1",
  "dor_pe": "0",
  "mal_lat": false,
  "mal_med": false,
  "base5": false,
  "navic": false,
  "carga": false,
  "contexto": "1"
}

Expected result

{
  "tornozelo": 0,
  "pe": 0
}

Actual result

{
  "tornozelo": 0,
  "pe": 0
}

Source for the active edition

Stiell et al. · Ottawa ankle · original 1993 article

Additional reading and history

Identifier: regras-de-ottawa-tornozelo

Original clinical content: Brazilian Portuguese.

Code and reproducibility

This tool’s code on GitHub

Download code and tests

Sources, version and reproduction instructions

The code tests are technical checks. Clinical approval and professional translation review are recorded separately.

Relationship with cancer research

General context — relationship to be defined

A resource for general clinical contexts. This edition does not assign a specific oncological relationship; selecting it for a study requires a justified question, population and purpose.