Physical Exam

Ottawa Foot Rule

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Video coming September 2026

How to Perform

In a patient with an acute foot injury and pain in the midfoot zone, assess the three Ottawa Foot Rule criteria: bony tenderness at the base of the fifth metatarsal; bony tenderness over the navicular; and inability to take four weight-bearing steps both immediately after the injury and at the time of evaluation. The rule is positive if any one of these criteria is present.

How to Interpret

Midfoot Fracture

Ottawa foot rule positive

Rule in

—

Rule out

Very helpfulDerived CI

Evidence:Strong

References

Bachmann LM, Kolb E, Koller MT, Steurer J, ter Riet G. Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review. BMJ. 2003;326(7386):417. PMID: 12595378.
Bachmann LM, Kolb E, Koller MT, Steurer J, ter Riet G. BMJ. 2003;326(7386):417. PMID: 12595378. Stiell IG, Greenberg GH, McKnight RD, Nair RC, McDowell I, Worthington JR. A study to develop clinical decision rules for the use of radiography in acute ankle injuries. Ann Emerg Med. 1992;21(4):384-390. PMID: 1554175.
Stiell IG, Greenberg GH, McKnight RD, Nair RC, McDowell I, Worthington JR. A study to develop clinical decision rules for the use of radiography in acute ankle injuries. Ann Emerg Med. 1992;21(4):384-390.

Research last updated September 10, 2026.