Ottawa - Buffalo Modification for Ankle Exam

The incidence of ankle fractures in athletes invovled in controlled sports activities is relatively low. However, the decision(s) on which ankles to study radiographically with x-rays is not always easy. Not all ankle or foot injuries require immediate x-rays. The allied health practitioner can determine to a relatively accurate degree the need for futher study through a good clinical exam and by following the Ottawa Ankle Rules and with the use of the Buffalo Modification. (for more information, consult the AJSM, Vol 26, No 2. 1998)

Research has shown that in a hospital based E.R. of every 6 ankles approved for x-ray under the O.A.R. (Ottawa Ankle Rules), 5 have no radiographic findings. Steill, I.G., JAMA, 269:1127-1132, 1993.

• Clinical ankle exam

If the patient needs x-rays, they will usually present with lateral fibular malleolus pain in the distal 6 cm, medial tibial malleolus pain in the distal 6 cm or pain to palpation over the proximal tip of the 5th metatarsal or the Navicular.

The inability to bear weight may indicate a lesion to the dome of the Talus or other associated trauma to the other structures of the ankle which may require x-ray study.

Distal 6 cm of either the medial or lateral malleolus		5th Metatarsal or Navicular pain