Unnecessary radiographs of the ankle and foot following injury can be reduced by the use of some simple guidelines.
Criteria for ankle radiographic series - both (1) and (2):
(1) pain in malleolar zone (distal 6 cm of tibia and fibula and talus)
(2) any one of the following
(2a) bone tenderness at the posterior edge or tip of lateral malleolus
(2b) bone tenderness at the posterior edge or tip of medial malleolus
(2c) inability to bear weight both immediately and in the emergency department using 4 steps
Criteria for foot radiographic series - both (1) and (2):
(1) pain in midfoot zone (navicular bone, cuboid, cuneiforms, anterior process of calcaneus, and base of the fifth metatarsal)
(2) any one of the following:
(2a) bone tenderness at the base of the fifth metatarsal
(2b) bone tenderness at the navicular bone
(2c) inability to bear weight both immediately and in the emergency department using 4 steps
Evaluation:
• the criteria are 100% sensitive for significant fracture
• patient satisfaction and need for subsequent radiography similar in populations with or without rules
