Diagnostics

These criteria are used to determine the need for X-rays in patients presenting to the emergency department (ED) with traumatic ankle and/or foot injuries.

• Ankle x-rays are indicated for pain in the malleolar region PLUS any of the following:

  • Tenderness along the posterior distal 6 cm of the:

    • Lateral malleolus

    • OR medial malleolus

  • Weight-bearing is impossible both immediately post-injury and in the ED.

• Foot x-rays are indicated for pain in the midfoot region PLUS any of the following:

  • Tenderness at the:

    • Base of the 5thmetatarsal

    • OR the navicular bone

  • Weight-bearing is impossible both immediately post-injury and in the ED.

• 3-view plain ankle x-ray: anteroposterior (AP) , lateral and mortise (oblique) views

• Tibia fibula x-ray: AP and lateral views to evaluate for pilon or Maisonneuve fracture

• Ankle sprain

• Foot fracture

• Stress fracture

• Tarsal tunnel syndrome

• Arthritis (e.g., osteoarthritis, gout, pseudogout, septic arthritis)

• Achilles tendon rupture

• Charcot joint