There are medical secrets, and there are tips. Then there are initiatives that help the public better understand what’s going on, like the big initiatives on heart attacks and strokes. I wonder why there’s never been a push to teach the public how to better deal with strains and sprains. The cumulative radiation exposure and the expense of coming to the emergency room are sufficiently high enough that we should want patients not to expect as many unwarranted x-rays as you end up receiving. Truthfully, the overwhelming majority of ankle sprains (consistently estimated at 85%) don’t have associated fractures. The initial research done in developing what are known as the Ottawa Ankle Rules demonstrated a complete absence of ankle fractures in the absence of certain exam findings.
An ankle X-ray is only required if any of the following are present (Doctor version).
- Inability to bear weight for four steps (both immediately and in the emergency room);
- Bony tenderness along the posterior edge of the distal 6 cm (almost 3 inches) of either the lateral or medial malleolus;
- Point tenderness over the proximal base of the 5th metatarsal; or
- Point tenderness over the navicular bone.
Now that was the medical terminology (I bet you thought I’d lost it for a second!). Here’s the same information translated for you.
- Inability to bear weight for four steps (both immediately and in the emergency room);
- Bony tenderness along the back of those big bones sticking out of either side of your ankle (A and B in the diagram above);
- Point tenderness right about the middle of your foot down from your pinky toe (C in the diagram); or
- Point tenderness over top of the middle of your foot (D in the diagram).
These rules aren’t applied to those under 18, intoxicated or otherwise distracted, say from another injury.
What does this mean?
- More than a third of ankle x-rays can be eliminated by applying these rules, saving you money and radiation exposure.
- If you find your physician asking you if you’d like to not have an x-ray done, you know this is what s/he’s thinking. Several major studies showed application of these rules had a 100% sensitivity. In other words, you don’t need the x-ray.
- All of you playing with your ankles have made me smile.
What this doesn’t mean for you…
- You can play doctor at home.
Finally, don’t forget about RICE, remember? That’s how you treat your ankle sprain.
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