How to examine the ankle and foot (Ottawa rules)
Other platforms explain it with text and video. In Making Synapses you practice it on the patient.
The Ottawa ankle rules help decide who needs an X-ray after an ankle injury.
Step by step
Look
Swelling, bruising, deformity. [1]
Feel the key points
Back edge and tip of both malleoli (6 cm), base of the fifth metatarsal, navicular. [2]
Ottawa ankle rules
X-ray if bone tenderness at those points or cannot take four steps right after the injury and in the clinic. [2]
Move
Up, down, in, out. [1]
Stability
Anterior drawer for ligament injury. [1]
Pulses and nerves
Dorsalis pedis, posterior tibial, sensation. [1]
Achilles
Thompson test: squeeze the calf, the foot should point down. [1]
Common errors
- X-ray for everyone.
- Missing the fifth metatarsal.
- Not testing the Achilles.
Practice it in Making Synapses
In Making Synapses you do this on the patient, not on paper: every step goes on the checklist with a score, and in Teach mode Blocky tells you what comes next.
Making Synapses cases that train this skill
- Rattlesnake bite
- Dilated cardiomyopathy
- Chronic venous insufficiency
- Hand-foot-and-mouth disease
- Stasis dermatitis
- Refeeding syndrome
21 Making Synapses cases train this skill: open the case library
Sources
- Stanford Medicine 25 (bedside exam)
- NCCPA PANCE Content Blueprint
- Open RN, Nursing Skills 2e (Chippewa Valley Technical College) (CC BY 4.0)
Steps adapted from Open RN, Nursing Skills 2e (Chippewa Valley Technical College), licensed under CC BY 4.0. Facts and steps also follow NCCPA PANCE Content Blueprint; Stanford Medicine 25 (bedside exam). Making Synapses is not affiliated with these organizations. Updated: 2026-10-11.