The most common question asked from patients with an ankle injury is “Should I get my ankle scanned?”.
Often the answer is “it will not change our treatment”.
However, for your ankle there is a clear cut set of rules to help decide whether you should get an X-ray or not. They are called the Ottawa Rules, and they determine whether or not you should get your ankle scanned.
When a physio asks about ankle tenderness, we mean that you want to pull your foot away when it is pressed, not that it’s just a little achy.
Please note that the below is how health professionals work out when to send you for an ankle scan. Knowing this may help you decide whether you should just put some ice on it or you should go and see your GP or physiotherapist for further advice.
Ottawa Ankle Rules:
1. Can you bear weight after injury?
Immediately after you go over on your ankle, were you able to bear weight through your foot? If you answer no, then you require an x-ray to rule out a fracture.
2. Do you have a bony tenderness along the posterior edge of the distal fibular?
Is the back of your outside ankle bone tender, anywhere from the tip to 6cm up? If so you need an x-ray to rule out a fracture.
3. Do you have a bony tenderness along the posterior edge of the distal tibia?
Is there any tenderness on the back of the inside ankle bone, anywhere from the tip to 6cm up? If so, you require an x-ray to rule out a fracture.
4. Are you tender at the base of the 5th metatarsal?
When you press on the outside edge of your foot, running from your little toe back, are you tender when you get to the end of the bone, just before it drops into a bit of a hollow? That is the base of the 5 th Metatarsal.
5. Are you tender over the Navicular bone?
The first bone after your ankle on the inside of your foot is the navicular bone. Tenderness on this bone could represent a fracture and should be X-rayed to rule it out.
Now even if you are not tender in any of these areas and are able to weight bearing ankle an ankle injury, I highly recommend a physiotherapist appointment 2-3 days post injury.
The reason for this is to ensure that you regain full active range of motion (AROM) in the ankle. A lack of ankle AROM is a big reason for other injuries later.
Ankle range can affect how your knee, hip and lower back move and load.