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Hospital Misdiagnosis of Foot and Ankle Fractures - Sylvia Taylor, Tilly Bailey & Irvine

14/08/17. Foot and ankle injuries are a common place reason for attending the Accident and Emergency Department or Minor Injuries Unit. However, not everyone with an ankle and foot injury will need an x-ray.

In 1992 the Ottawa Ankle and Foot Rules were devised by an emergency physician in Canada, who wanted to find a way to cut down on the number of x-rays. The original rules recommended ankle x-rays if:-

  1. 55 years of age or over,

  2. Were unable to bear weight for four steps both immediately and at the time of evaluation,

  3. Experienced bone tenderness at the posterior edge or inferior tip of the lateral malleolus,

  4. Had bone tenderness at the posterior edge of inferior tip of the medial malleolus.

An x-ray of the midfoot was recommended for patients with bone tenderness at the base of the fifth metatarsal, cuboid or navicular.

Currently the rules to determine when x-rays are required are set out below.

An ankle x-ray should be performed when:-

  1. There is an inability to weight bear, both immediately after the incident and in the casualty department,

  2. When there is bone tenderness at the edge or tip of the lateral malleolus,

  3. When there is bone tenderness of the posterior edge or tip of the medial malleolus.

A foot x-ray is required if there is:-

Image: public domain

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