Overuse of concomitant foot radiographic series in patients sustaining minor ankle injuries

Emerg Radiol. 2010 Jul;17(4):261-5. doi: 10.1007/s10140-009-0846-2. Epub 2009 Oct 16.


Radiographic series of the foot are often obtained in conjunction with ankle X-rays when the clinical presentation is limited to trauma to the ankle. The Ottawa Ankle and Foot Rules were established in 1992 and serve as reliable guidelines to determine when an ankle or foot series is warranted in patients who have sustained minor ankle and/or foot injury. We retrospectively reviewed radiographic studies of all patients over a period of 18 months who simultaneously had ankle and foot plain radiographs performed for acute complaints limited to the ankle alone. Of the 243 patients who met our inclusion criteria, 55 patients had fractures, 46 in or near the ankle joint, and nine which were located at the base of the fifth metatarsal bone. No fractures or dislocations were noted elsewhere in the foot. All of the fifth metatarsal fractures were evident on adequately performed ankle series. Our findings suggest that films of the foot are not necessary when trauma is limited to the ankle and when an appropriately performed ankle series has been completed.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Ankle Injuries / diagnostic imaging*
  • Child
  • Child, Preschool
  • Decision Support Techniques*
  • Female
  • Fractures, Bone / diagnostic imaging
  • Humans
  • Male
  • Metatarsal Bones / diagnostic imaging
  • Middle Aged
  • Radiography
  • Retrospective Studies
  • Unnecessary Procedures*