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Clinical Prediction Rules

1. Ottawa Ankle CPR to rule in/out radiography of the ankle after trauma


Ages 2-55: Order radiograph if one or more of the following is met:

  • Tender over posterior distal tip of the medial or lateral malleolus
  • Tenderness over base of the 5th metatarsal or navicular bone
  • Inability to bear weight (4 steps) both immediately and in in the emergency room

2. Ottawa Foot CPR to rule in/out radiography of the foot after trauma


Order x-ray if:

  • Pain in the midfoot zone and any one of the following:
    • Tenderness over the navicular or base of the 5th metatarsal
    • Unable to bear weight for 4 steps immediately after injury and during exam


1. Stiell IG, Greenberg GH, McKnight RD, et al. Decision rules for the use of radiography in acute ankle injuries. JAMA. 1993;269:1127-1182. 

2. Wolfe MW, Uhl TL, Mattacola CG, and McClucskey LC. Management of ankle sprains. Am Fam Physician. 2001;63(1):93-105.