Do I Need An X-ray After An Ankle Injury?

The Ottawa Ankle Rules are a set of guidelines that doctors and healthcare professionals use to help us decide if a patient should have an x-ray after an ankle injury. They should be used in conjunction with a thorough subjective and objective examination by a healthcare professional.

Indicators that further imaging (such as x-rays) is required are:

  1. An inability to weight bear or take up to 4 steps immediately after injury, or when you see one of our physiotherapists.
  2. Bone tenderness at the back of the edge of the tibia or fibula (the back part of the bones either side of your ankle)
  3. Bone tenderness at the navicular (inside foot bone just beyond the ankle),
  4. Bone tenderness at base of the 5th metatarsal (the bump on the outside of your foot, about halfway down) 


Picture – Credit – British Medical Journal BMJ 2003;326:417

If you fit one or multiple of these scenarios listed above, then ankle imaging is recommended.

Other situations where we recommend that you see a physiotherapist:

  1. Numbness/ loss of sensation that is constant
  2. Severe constant ankle pain even when non weight bearing 
  3. Severe ankle swelling that does not improve within 1 week
  4. New feeling of ankle instability/rolling the ankle when walking
  5. No change/improvement in ankle pain or dysfunction after 1-2 weeks 

Remember these guidelines only help to decide of you should have an x-ray or not. It is always smart to have your ankle properly examined by a physiotherapist to get a proper diagnosis and start you on your road to recovery.

Should you like to book an appointment with one of our physiotherapists, then please call us on 01293 365011 or email
Appointments can be booked online here

The information contained in this article is intended as general guidance and information only and should not be relied upon as a basis for planning individual medical care or as a substitute for specialist medical advice in each individual case.



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