MEDICAL: Ottowa Ankle Rules - Are you hurt or injured?

Dude, Just walk it off its not that bad

In a wilderness survival or tactical environment how can you tell if you’ve sprained or broken an ankle?  The distinction may seem minor, but the implications are dramatic. In a wilderness environment it means the difference between wrapping the ankle and the patient can walk out, or immobilizing the limb and carrying the patient out.

Tactically, the distinction is the same, but instead of having another shooter, you have a casualty.

So here is a field expedient method to determine if an ankle is broken or sprained.  It called the Ottowa Ankle Rules.

(This isn’t completely fool-proof, so use some common sense.  If the patient’s foot/ankle is obviously deformed then it’s safe to assume it’s broken and don’t let the patient put any weight on the foot.)

Ottowa Ankle Rules

Begin by palpating (feeling) the ankle or foot at a site away from the injury.  Slowly work towards the site of injury.

If the patient has pain on the top of the ankle/lowest 6cm portion of the leg (malleolar zone, see picture) AND point tenderness on the side of the bone where the leg bone meets the ankle (either A or B) then assume it’s a broken ankle.


If the patient has foot pain near the ankle (midfoot zone, see picture) AND point tenderness on the bones on either side of the foot closest to the ankle (either C or D) assume it’s a broken foot.


Patient can’t walk four consecutive steps without assistance (limping counts) then assume it’s a fracture of something.

Medial – Groovy piggy bank not included

If the patient doesn’t have the above indicators, then it’s probably a sprain or the patient is a whiney pussy.

Why take the time to distinguish between a fracture or a sprain?

These rules were originally developed to decrease the amount of unnecessary x-rays in the emergency department, but for wilderness medicine or contractors this test will determine whether you need immediate care, or you can continue what you’re doing.

A fracture means that you are out of action and will need to be seen by a medical professional.  Wilderness First Aid steps are to wrap/splint the foot to eliminate movement, elevate if possible, take some pain relievers (ibuprofen or acetaminophen) and try to not put any weight on the foot as it may cause more damage, and will certainly be painful.

Ice may be hard to come by, but a cold pack will help with the swelling and pain.  You will need to be carried or use a crutch of some sort to get wherever you need to go, preferably to medical care.  R.I.C.E – Rest, Ice, Compression, Elevation.

A sprain, while painful and may limit your mobility, means that you can still put weight on the foot.

So tighten the laces on your boot, take a couple of ibuprofen and man up.


~John B Correspondent - Medical and S&R

John B has been an EMT for 18 years and is currently a Field Team Leader for a Search and Rescue Team, he also holds a Master's degree in Neuroscience.