When To Get an X-ray On Ankle?

May 4, 2024 5:30:00 AM / by Chad Hutchison

Ankle sprains are one of the most common forms of injury, often caused by sports or outdoor activities, but they can also happen at home or even while walking down the street. If you’re experiencing sudden pain in your foot or ankle, you may consider getting an X-ray. 

X-ray imaging is a valuable diagnostic tool for determining if there’s a fracture. However, not all sprains result in fractures, and not all require X-rays. Here, we’ll examine the Ottawa Ankle Rules (OAR) and other factors to help you decide if you need an X-ray. 

When Should You Get an X-Ray On Your Ankle?

Ottawa Ankle Rules and Other Symptoms

The OAR guidelines determine if X-rays (aka radiographs) are necessary to reduce unnecessary imaging. These rules state that if you can take four steps and don’t have the tenderness described below, there’s a high degree of certainty you don’t have a fracture. 

However, if you experience any of the following, you may need podiatry X-ray imaging to confirm or rule out fractures. Here are the rules:

  • Inability to bear weight or take up to four steps immediately after injury.
  • Bone tenderness at the back edge of the tibia or fibula (the ends of our leg bones at the ankle joint).
  • Bone tenderness at the navicular (inside foot bone just beyond the anklebone) or base of the 5th metatarsal (the most outside foot bone) 

Other symptoms that may require imaging or a visit to a podiatrist include:

  • Constant numbness.
  • Severe pain even when non-weight-bearing.
  • Minor swelling and bruising are normal with sprains, but seek help if the swelling is severe and doesn’t improve within a week.
  • A new feeling of instability/rolling the ankle when walking.
  • No change/improvement in pain or dysfunction after 1-2 weeks.

Types of Fractures and Sprains

Podiatry X-ray imaging is a powerful tool for diagnosing fractures. Let’s examine some common fractures and sprains.

  • Lateral or inversion sprains are the most common injury and can cause reinjury if not properly managed. They involve partial or complete tearing or disruption of the ligaments on the outside of the anklebone. 
  • Medial or eversion sprains involve injuries to the deltoid ligament on the ankle's inside (medial side).
  • High ankle sprains, also called “tib” or “fib” sprains, are when the ligaments that hold the two leg bones (tibia and fibula) together at the top of the anklebone are injured. 
  • Lateral malleolus fractures are the most common fractures caused by a break of the lateral malleolus, the knobby bump on the outside of the anklebone.
  • Bimalleolar fractures are the second-most common fracture, involving lateral and medial malleolus breaks, the knobby bumps on the inside of the anklebone.
  • Trimalleolar fractures involve breaks in three sides: the medial and lateral malleolus and the lower part of the posterior malleolus of the tibia.
  • Pilon fractures are through the ankle's weight-bearing " roof, " the lower tibia's central part.

Ankle X-Ray Screening Questions

Here are some screening questions to determine if podiatric X-ray imaging is necessary. 

Can You Take 4 Steps?

It’s okay if you are limping, but get a radiograph if you cannot physically take four steps. 

Do You Have Tenderness or Pain Around Your Medial or Lateral Malleoli? 

If you have pain in the backside of the little bone bumps on either side of your anklebone, radiographs are needed. 

Do You Have Tenderness or Pain Around the Base of the 5th Metatarsal? 

Get a radiograph if you experience tenderness in the bump on your foot's lateral/outside portion, about halfway between your heel and little toe. 

Do You Have Tenderness or Pain Around the Navicular Bone?

If you have pain or tenderness in the bump on the medial or inside portion around the middle of your foot, get an X-ray. 

Frequently Asked Questions

Does a Sprained Ankle Show up on X-Ray?

Sprained ankles are soft tissue injuries that don’t appear on X-rays, so most sprains don’t require radiographs. The Ottawa Ankle Rules rule out fractures and prevent unnecessary X-rays. However, if a fracture is suspected, then radiographs are needed.

Can You Tell if an Ankle Is Broken Without an X-Ray?

Unless your anklebone is at a noticeably odd angle, you can’t tell if it’s broken. Fractures can present very similar symptoms to sprains. We use the Ottawa Ankle Rules to determine if an X-ray is needed to diagnose the problem. 

Final Thoughts

Ankle sprains and fractures are the most common ankle injuries and present similar symptoms. Since sprains generally don’t require radiographs, the Ottawa Ankle Rules are valuable in ruling out fractures and reducing unnecessary imaging. However, if you or your patients answered yes to those rules, then it’s critical to have X-ray imaging to diagnose the problem. 

Quality equipment like Maven Imaging’s Podiatry X-ray Machines can help you diagnose the problem quickly and safely so you can move on to the appropriate treatment. Maven also provides industry-proven insight to help you diagnose issues and decide on treatment. 

Tags: x-ray, ankle x-ray

Chad Hutchison

Written by Chad Hutchison

Founder and CEO of Maven Imaging, Chad Hutchison has been in the medical imaging equipment market since 2003. As his business grew, he pioneered buying and selling medical equipment online and eventually began offering leasing and financing to meet market demands and help customers. His market expertise goes beyond traditional medical imaging and finance support, as he’s spearheading cloud-based lending solutions for vendors across the sector.