When do I need an X-ray (x-radiation) for an ankle injury?

From the Guidelines

You should get an X-ray for an ankle injury if you meet the Ottawa Ankle Rules criteria, which include inability to bear weight immediately after the injury, point tenderness over specific areas of the ankle, or inability to walk four steps in the emergency department. The Ottawa Ankle Rules are a widely accepted and validated tool for determining the need for radiographs in patients with acute ankle trauma 1. These rules recommend X-rays if you have pain near the ankle bones (malleoli) and either cannot walk four steps immediately after the injury or during examination, or have bone tenderness at specific points of the ankle. X-rays are necessary to rule out fractures, which require different treatment than sprains. While most ankle injuries are sprains that heal with conservative management, fractures may need immobilization or surgery.

Some key points to consider when deciding if you need an X-ray for an ankle injury include:

• Inability to bear weight on the affected foot
• Significant swelling or bruising
• Pain or tenderness over the ankle bones (malleoli)
• Inability to walk four steps immediately after the injury or during examination
• A popping sound during the injury
• Visible deformity or numbness
• Pain that is unbearable even with over-the-counter pain medications

It's essential to seek medical evaluation if you're unsure about the severity of your injury, as a proper diagnosis and treatment plan can help prevent long-term complications and improve outcomes 1. The use of X-rays and other imaging modalities should be guided by evidence-based clinical guidelines, such as the Ottawa Ankle Rules, to ensure appropriate and timely treatment.

From the Research

Determining the Need for an X-ray for an Ankle Injury

To determine if an X-ray is needed for an ankle injury, consider the following factors:

• Severity of the injury: If the injury is severe, an X-ray may be necessary to rule out fractures or other serious damage 2.
• Symptoms: If symptoms such as pain, swelling, or instability persist, an X-ray may be necessary to evaluate the extent of the injury 3.
• Medical history: If the patient has a history of ankle fractures or other ankle problems, an X-ray may be necessary to evaluate the current injury 2.

Types of Ankle Injuries that May Require an X-ray

The following types of ankle injuries may require an X-ray:

• Fractures: X-rays are commonly used to diagnose fractures, including malleolar fractures 2.
• Ligament injuries: While X-rays may not be the best imaging modality for ligament injuries, they may be used in conjunction with other imaging modalities such as MRI to evaluate the extent of the injury 4.
• Tendon injuries: X-rays may be used to evaluate bony abnormalities associated with tendon injuries, but MRI is generally preferred for evaluating soft tissue injuries such as tendon injuries 5.

Imaging Modalities for Ankle Injuries

The following imaging modalities may be used to evaluate ankle injuries:

• X-ray: X-rays are commonly used to diagnose fractures and other bony abnormalities 2, 3.
• CT scan: CT scans may be used to evaluate more complex ankle injuries, such as malleolar fractures, and to identify pathologies that may be overlooked on X-ray 2.
• MRI: MRI is generally preferred for evaluating soft tissue injuries such as ligament and tendon injuries, and can provide detailed images of the ankle joint and surrounding tissues 6, 5, 4.