I just rolled my ankle really bad, do I need an X-Ray?

Ankle sprains are one of the most common injuries we experience at least once or twice in our lifetime. Whether it be on the sports field such as landing awkwardly or changing direction suddenly such as basketball or netball, to even stepping on an uneven surface while walking along the footpath.

Rolling your ankles inwards can be very painful and this is largely due to the sudden and excessive force taking the joint past its physiological barrier. Thankfully the majority of ankle sprains are not accompanied by a fracture. So to avoid unnecessary time waiting in emergency rooms, money spent and health risk associated with radiation exposure, here are simple guidelines that are very reliable in determining whether it’s just a really bad sprain or whether an actual fracture has occurred at the foot or ankle.

These guidelines are known as the Ottawa Ankle Rules and they are as follows:

When do I need an ankle x-ray?

An ANKLE X-Ray is recommended if:

There is any pain in the MALLEOLAR zone and…

  • Tenderness at the back edge or tip of the lateral malleolus, or
  • Tenderness at the back edge or tip of the medial malleolus, or
  • An inability to weight-bear both immediately and in the emergency department for four steps (“weight-bear” counts even if the patient limps)

When do I need a foot x-ray?

A FOOT X-Ray is recommended if:

There is any pain the MIDFOOT zone and…

  • Tenderness at the base of the fifth metatarsal, or
  • Tenderness at the navicular, or
  • An inability to weight-bear both immediately and in the emergency department for four steps (“weight-bear” counts even if the patient limps)

When should I see a practitioner?

It can sometimes still be difficult to know when you need an X-ray. Your Physiotherapist, Osteopath or Podiatrist will be able to give you diagnosis and will be able to refer you for x-rays or imaging after assessing you.

Clinical judgement should prevail over the rules if the patient…

  • is intoxicated or uncooperative
  • has other distracting painful injuries elsewhere
  • has reduced sensation in the legs
  • has gross swelling which prevents feeling of the malleolar tenderness