When Does A Sprained Ankle Require An X-Ray? Find Out Here

As a parent of 2 young children, I have encountered the age old question of  “Do I really need to bring my kid into the doctor for this?” many times.  As our kids grow up leading active lives, they are bound to experience some bangs, bumps, bruises, twists, and sprains along the way.  Some of these seem to be of little to no consequence.  Others well, ………seem to leave you at a crossroads.  Should I bring my kid into the doctor or physical therapist?  Will they need an x-ray to see if there is a fracture or not?

It sure would be helpful if there were a set of rules to help make this decision.  As it turns out, for the ankle at least, there is.

The Ottowa Ankle Rules were developed in 1992 and have proven to be a very reliable and sensitive tool for clinicians to rule out the likelihood of ankle and midfoot fractures in children (>5 years old) 1 and adults (*footnote).  The rules pertain to specifically where the injured person has pain, whether they have any bony tenderness to palpation in specific areas, and whether they are able to bear weight on that foot for 4 steps immediately after the injury and again in the Emergency department.  These criteria can be reviewed in the following diagram.

(Note: As this was initially used primarily in Emergency Departments but is now being extended to other clinical settings, you will need to substitute being able to take 4 complete steps both immediately and again later that day / evening for the time factor it would have taken to go into the ER.)

The Physical Therapists at OSI have been trained to effectively utilize this tool and to determine whether or not X-rays are indicated for ankle / midfoot injuries.  In the event that X-rays are indicated, a proper referral back to your child’s physician will be made and if no X-rays are indicated, they have already been evaluated by a physical therapist and are in just the right place to begin rehabbing their injury.

Thanks for reading!

– Nate

When Does A Sprained Ankle Require An X-Ray? Find Out Here


Academic Emergency Medicine

Volume 16, Issue 4, pages 277–287, April 2009

Accuracy of Ottawa Ankle Rules to Exclude Fractures of the Ankle and Midfoot in Children: A Meta-analysis