The Ottawa Ankle Rule is a clinical tool used primarily in emergency medicine to determine the need for radiographic imaging in patients with ankle and midfoot injuries. It is designed to rule out fractures in these areas and thus reduce unnecessary X-rays. The rule applies to patients who have ankle or midfoot pain or tenderness and are unable to bear weight both immediately after the injury and in the emergency department. The Ottawa Ankle Rule is not applicable to patients who are under the age of 18, have other distracting painful injuries, are intoxicated, have diminished sensation in the lower extremities, or are unable to understand the instructions or assessment due to language barriers or cognitive impairment.

Ottawa Ankle Rule

# Criteria
 A. Pain in malleolar zone
B. Pain in midfoot zone 
C. Tenderness at posterior edge or tip of lateral malleolus
D. Tenderness at posterior edge or tip of medial malleolus
E. Tenderness at the base of 5th metatarsal bone
F. Tenderness at navicular bone
G. Inability to bear weight both immediately and in emergency department

# Conditions
- (A and (C or D or G)) or (B and (E or F or G))
- true