Physical examination maneuver

Physical Exam

Ottawa Foot Rule

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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

Showing all 4 findings

Midfoot Fracture

Ottawa foot rule positive
Rule in
—
Rule out
Very helpful
Evidence:Strong
Bony tenderness at the base of the fifth metatarsal
Rule in
Very helpful
Rule out
Helpful
Evidence:Moderate
Inability to take four weight-bearing steps both immediately after the injury and at the time of evaluation
Rule in
Minimally helpful
Rule out
Minimally helpful
Evidence:Moderate
Bony tenderness over the navicular
Rule in
InconclusiveWide CI
Rule out
Not helpful
Evidence:Moderate

Related Bedside Tests

🎬Video coming soon
Ottawa Ankle Rule
Rule in:VHMidfoot Fracture, HAnkle Fracture, MHAnkle or Midfoot Fracture
Rule out:VHAnkle Fracture, VHAnkle or Midfoot Fracture, HMidfoot Fracture
Ankle Dorsiflexion-external Rotation TestMembers
Sign in
Ankle Dorsiflexion-external Rotation Test
aka Kleiger test
Rule in:ICAnkle Syndesmosis Injury
Rule out:ICAnkle Syndesmosis Injury
Thompson TestMembers
Sign in
Thompson Test
aka Simmonds test; Simmonds-Thompson test; calf squeeze test
Rule in:VHAchilles Tendon Rupture
Rule out:VHAchilles Tendon Rupture
🎬Video coming soon
Lower Extremity Inspection and Palpation
Rule in:VHDiabetic Foot Osteomyelitis, VHKnee Osteoarthritis, HAchilles Tendon Rupture +7 more
Rule out:SHAchilles Tendon Rupture, SHDiabetic Foot Osteomyelitis, SHKnee Osteoarthritis +7 more
🎬Video coming soon
Achilles Deep Tendon Reflex
aka Ankle jerk
Rule in:VHPeripheral Neuropathy, SHHypothyroidism, NHLumbosacral Radiculopathy +5 more
Rule out:VHPeripheral Neuropathy, MHHypothyroidism, NHLumbosacral Radiculopathy +5 more
🎬Video coming soon
Babinski Reflex
aka Plantar reflex
Rule in:VHUpper Motor Neuron Lesion, VHVascular Parkinsonism, HMultiple System Atrophy +4 more
Rule out:SHUpper Motor Neuron Lesion, MHMultiple System Atrophy, NHVascular Parkinsonism +4 more

Related Systems / Regions

Ankle and FootLower ExtremitiesMusculoskeletal

Related Diagnoses

Midfoot Fracture

Related Chief Complaints

Ankle InjuryAnkle PainAnkle SwellingBruisingDeformityDifficulty WalkingFoot PainInability to Bear WeightPain with Weight Bearing

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.
  • Yavas S, Arslan ED, Ozkan S, Yilmaz Aydin Y, Aydin M. Accuracy of Ottawa ankle rules for midfoot and ankle injuries. Acta Biomed. 2021;92(4):e2021241. doi:10.23750/abm.v92i4.9962. PMID: 34487104. PMC8477123.
  • 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.