I Just Rolled My Ankle! How do I know if I need an x-ray!?

You were playing basketball or you clumsily fell off a curb rolling your ankle….hey, it happens. Unfortunately, your ankle swells up like a balloon and it’s painful to even put weight on it. Now you are concerned that it might actually be more serious. Ankle sprains are incredibly common, but when do you know if it’s a fracture or just an ankle sprain? Don’t worry, I’m here to guide you along the right path.

Ottawa Ankle Rules

In the rehab realm, we use a set of rules known as the Ottawa Ankle Rules to help determine if you might have a possible fracture or if you should just treat it like a normal ankle sprain. If you feel you have met any of these criteria then don’t stress, just go get an x-ray. To best understand these rules I’m going to cover some foot and ankle anatomy while including visual aids.

Disclaimer: These rules are not 100% set in stone and are meant to be used as guidelines. Your best bet is to always find a local medical provider to give you proper medical advice suited for you.


The first critical landmark is the bony projection on the outer part of your ankle known as your lateral malleolus. Now, the first Ottawa rule states if the back half of this bone is painful to the touch then it’s time to get an x-ray. (Note: those with normal ankle sprains will have pain just below this bone.

Rule number two states if the bony projection on the inner half of your ankle, the medial malleolus, hurts to touch then it’s time to get an x-ray.

The next rule is pain over the bone located at the inner part of the arch of the foot known as the navicular bone.

The last landmark is located on the opposite side of the navicular on the outside of your foot. To better locate it, go to your pinky toe then trace it down until you hit the halfway point of your foot. This is known as the base of the 5th metatarsal. If this area is painful, then….you guessed it, x-ray time.

The final rule is the ability to bear weight for at least 4 steps. This means, after you roll your ankle if you can limp around and walk at least 4 steps putting some weight on that foot/ankle then you more than likely don’t have a foot or ankle fracture.


As active human beings, there is a good chance that you are going to roll your ankle at least once in your lifetime. If any of the four locations mentioned above or you are unable to bear weight on your ankle for at least 4 steps then it’s a good idea to get an x-ray. To reiterate, these are just guidelines and it’s always best to see a local certified medical provider. In a future blog post, I will write how to treat an ankle sprain and different exercises to get you up and running again! If you have any more questions feel free to email me at mat@parkerphysio.com.


Or you can download our FREE report on the foot and ankle “6 Essentials Tips To Reduce Foot And Ankle Pain (Including Plantar Fasciitis And Achilles Tendonitis) In 14 Days” by clicking this link HERE! 

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