“Ouch! I think I twisted my ankle…..”
Isn’t this such a common phrase that we hear from friends and families around us? Ankle sprain is such a common injury but yet at times, can be a complex case to treat depending on its severity. Furthermore, it will be a completely different story if the bones in our ankle are involved. How then do we determine whether there are bones involved and whether radiographs are needed? Before we go further, let us have a quick go through of the different grades of ankle sprain based on severity.
Gradings of Ankle Sprains
Grade 1
- Slight stretching and microscopic tear of the ligament
- Mild tenderness, swelling, and bruising
- None to minimal pain with standing
- No instability with examination
Grade 2
- Partial tear of the ligament
- Moderate tenderness, swelling, and bruising
- Mild pain with standing
- Mild instability with examination
Grade 3
- Complete tear of the ligament
- Remarkable tenderness, swelling, and bruising
- Significant pain with standing
- Considerable instability with examination
“But how can we determine whether there is any fracture at my ankle?”
Don’t worry! There is a quick and simple test to rule out ankle fracture called the “Ottawa Ankle Rule”.
Ottawa Ankle Rules
- Bony tenderness along distal 6 cm of posterior edge of fibula or tip of lateral malleolus
- Bony tenderness along distal 6 cm of posterior edge of tibia/tip of medial malleolus
- Bony tenderness at the base of 5th metatarsal
- Bony tenderness at the navicular
- Inability to walk 4 steps immediately after injury or at the emergency department
Ankle X-rays are only needed if:
- There is pain in the malleolar zone; and,
- Any one of the following:
- Bone tenderness along the distal 6 cm of the posterior edge of the tibia or tip of the medial malleolus, OR
- Bone tenderness along the distal 6 cm of the posterior edge of the fibula or tip of the lateral malleolus, OR
- An inability to bear weight both immediately and in the emergency department for four steps.
Foot X-rays are only needed if:
- There is pain in the midfoot zone; and,
- Any one of the following:
- Bone tenderness at the base of the fifth metatarsal (for foot injuries), OR
- Bone tenderness at the navicular bone (for foot injuries), OR
- An inability to bear weight both immediately and in the emergency department for four steps.
.
“How reliable and accurate is this test?”
Evidence supports the Ottawa ankle rules as an accurate instrument for excluding fractures of the ankle and mid-foot. The instrument has a sensitivity of almost 100% and a modest specificity, and its use should reduce the number of unnecessary radiographs by 30-40%. A patient who presents with 0 of the symptoms is less than 1% likely to have a fracture
Now that we know whether radiographs are needed after an ankle sprain, it will greatly save our time and our resources
Click on the link below to see how this test is performed
References:
- Bachmann, L. M., Kolb, E., Koller, M. T., Steurer, J., & ter Riet, G. (2003). Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review. Bmj, 326(7386), 417.
- (2022). Ottawa Ankle Rules. Retrieved from https://www.physio-pedia.com/index.php?title=Ottawa_Ankle_Rules&oldid=311471.
- Kruckeberg, B. M., Beahrs, T., & Haddad, S. L. (2022). Sprained Ankle. Retrieved from https://orthoinfo.aaos.org/en/diseases–conditions/sprained-ankle/
- Bux, S. (2018). Different Types Of Ankle Sprains, Symptoms & Treatment Options. Retrieved from https://www.bodyheal.com.au/blogs/sports-injuries/different-types-of-ankle-sprains-symptoms-treatment#anklespraingrades
- Physiotutors. (2016, August 19). The Ottawa Ankle Rules | Ankle Fracture Clinical Prediction Rule. YouTube. https://www.youtube.com/watch?v=KDkkhGZF1TI
Article by:
Yu Han
Your Physio Cheras