Is it broken? What to do when you twist your ankle

Have you ever fallen and twisted your ankle? The other day this happened to me when I slipped on the stairs by my porch. I was shocked at how much pain there was and thought that it might be broken. Since I was at home with my young kids, rushing off to Urgent Care seemed impossible. Luckily, I was able to perform these simple tests to help me determine that it was just a sprain and not broken.

Ottawa Ankle Rule

Ankle sprains are very common with estimates of 25,000 occuring per day in the USA¹. Since this is a daily routine in emergency departments, the Ottawa Ankle Rule was created to decrease healthcare costs and decrease the number of radiographs ordered. It is a rapid and accurate way to get an answer on the severity of an acute ankle injury. 

There are 5 Components to the Test:

1. Bony tenderness along distal 6 cm of posterior edge of fibula or tip of lateral malleolus
2. Bony tenderness along distal 6 cm of the posterior edge oft the tibia/tip of medial malleolus
3. Bony tenderness at the base of the 5^th metatarsal
4. Bony tenderness at the navicular
5. Inability to bear weight both immediately after injury and for 4 steps during initial evaluation

If pain is occuring during some of these steps it will determine if a person needs a foot or ankle x-ray. 

Here is a link to a click through website with all the questions that you can refer to. 

Exclusions

There are certain groups that are excluded from the Ottawa Ankle Rule, such as pregnant women, Inability to follow the test (head injuries, intoxication, etc). Studies on usefulness in kids under 6 years old is undetermined. 

What if I have no tenderness and can walk?

If you go through the test and notice that all are negative and it seems to be improving, then you may not need to go, or can wait till you have more help and support. I do still recommend seeing your local physical therapist to help get started on exercises for healing and prevention, as well as to have more eyes on your ankle in case other specialists are necessary. If you are in the Falls Church or Arlington, VA area, reach out to our office and schedule an appointment today!

Resources:

1. Doherty, C., Delahunt, E., Caulfield, B., Hertel, J., Ryan, J. and Bleakley, C., 2014. The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies. Sports medicine, 44(1), pp.123-140.
2. Kerkhoffs, G.M., van den Bekerom, M., Elders, L.A., van Beek, P.A., Hullegie, W.A., Bloemers, G.M., de Heus, E.M., Loogman, M.C., Rosenbrand, K.C., Kuipers, T. and Hoogstraten, J.W.A.P., 2012. Diagnosis, treatment and prevention of ankle sprains: an evidence-based clinical guideline. British journal of sports medicine, 46(12), pp.854-860.

Author

Alana Hamilton Alana Hamilton is a physical therapist at Advantage Physical Therapy in Falls Church, Virginia. She is a proud Hokie from Virginia Tech with a major in Biology and a minor in psychology and sociology. Following graduation, she immediately got her doctorate in Physical Therapy from Radford University. She is an avid fan of Pilates, running, and hiking. On the weekends, she can be found hanging out with her family and baby as well as doing Spartan races with her old physical therapy classmates and friends. She is a big believer that during rehabilitation, "Motion is the Lotion" and that staying active is key to remaining healthy.