By Joon Nah - Certified Vestibular Physiotherapist and Founder, Therapia

It has happened to the best of us. Perhaps you stepped off a curb or came down from a rebound on the basketball court and you felt the piercing pain of an ankle sprain. You will spend the next few moments trying to determine how bad it is. It can be everything from a ‘walk it off’ scenario, or a trip to the emergency room, or worse the operating room.

So how do you know if you should head home and get out the old ice pack, or have a friend take you to the doc for an x-ray? Thankfully there are some well-researched guidelines on whether an ankle sprain should be x-rayed. Apply these guidelines and you might save yourself a lot of time waiting for an x-ray you did not need.

The guidelines are called the Ottawa Ankle Rules. You can see a schematic at the bottom of this post that outlines them nicely.

You will notice, pain alone does not mean you need an x-ray. But you must have pain in either the malleolar zone (the bumps on either side of your ankle where it meets the top edge of a running shoe), or the midfoot zone (the first ⅓ of your foot). If you have pain in either of these areas then you move on to the next questions.

Pain in the Malleolar Zone

If your pain is around the bumps on either side of your ankle you must ask yourself two questions.

1. Is the back edge of either of your malleoli (A or B in the pic below) tender?
2. If your answer is YES to EITHER of these questions then you should get an x-ray. If it is no to both then you are very unlikely to have a fracture.

If your answer is YES to EITHER of these questions then you should get an x-ray. If it is no to both then you are very unlikely to have a fracture.

Pain in the Midfoot Zone

If your pain is on the flat part of your foot – near your leg (not out at your toes) you must ask yourself three questions.

1. Could you weight bear after the sprain?
2. Do you have tenderness on the base of your fifth metatarsal (C in the picture) or the navicular (D in the picture)
3. If your answer is YES to EITHER of these questions you should get an x-ray.

If none of these things are true, congratulations, get an ice pack and book an assessment with a physiotherapist.