broken ankle

MEDICAL: Ottowa Ankle Rules – Are you hurt or injured?

Dude, Just walk it off its not that bad

In a wilderness survival or tactical environment how can you tell if you’ve sprained or broken an ankle?  The distinction may seem minor, but the implications are dramatic.

In a wilderness environment it means the difference between wrapping the ankle and the patient can walk out, or immobilizing the limb and carrying the patient out.

Tactically, the distinction is the same, but instead of having another shooter, you have a casualty.

So here is a field expedient method to determine if an ankle is broken or sprained.  It called the Ottowa Ankle Rules.

(This isn’t completely fool-proof, so use some common sense.  If the patient’s foot/ankle is obviously deformed then it’s safe to assume it’s broken and don’t let the patient put any weight on the foot.)

Ottowa Ankle Rules

Begin by palpating (feeling) the ankle or foot at a site away from the injury.  Slowly work towards the site of injury.

If the patient has pain on the top of the ankle/lowest 6cm portion of the leg (malleolar zone, see picture) AND point tenderness on the side of the bone where the leg bone meets the ankle (either A or B) then assume it’s a broken ankle.

OR

If the patient has foot pain near the ankle (midfoot zone, see picture) AND point tenderness on the bones on either side of the foot closest to the ankle (either C or D) assume it’s a broken foot.

OR

Patient can’t walk four consecutive steps without assistance (limping counts) then assume it’s a fracture of something.

Lateral
Medial – Groovy piggy bank not included

If the patient doesn’t have the above indicators, then it’s probably a sprain or the patient is a whiney pussy.

Why take the time to distinguish between a fracture or a sprain?

These rules were originally developed to decrease the amount of unnecessary x-rays in the emergency department, but for wilderness medicine or contractors this test will determine whether you need immediate care, or you can continue what you’re doing.

A fracture means that you are out of action and will need to be seen by a medical professional.  Wilderness First Aid steps are to wrap/splint the foot to eliminate movement, elevate if possible, take some pain relievers (ibuprofen or acetaminophen) and try to not put any weight on the foot as it may cause more damage, and will certainly be painful.

Ice may be hard to come by, but a cold pack will help with the swelling and pain.  You will need to be carried or use a crutch of some sort to get wherever you need to go, preferably to medical care.  R.I.C.E – Rest, Ice, Compression, Elevation.

A sprain, while painful and may limit your mobility, means that you can still put weight on the foot.

So tighten the laces on your boot, take a couple of ibuprofen and man up.

—————————————————————————————

~John B
Correspondent – Medical and S&R

John B has been an EMT for 18 years and is currently a Field Team Leader for a Search and Rescue Team, he also holds a Master’s degree in Neuroscience.

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11 thoughts on “MEDICAL: Ottowa Ankle Rules – Are you hurt or injured?”

  1. I had the experience over christmas in the chiricahua mountains. solo hiking means self rescue. I posted a story of said same on my blog long ago. but it seems no one is interested in reading about an actual event.

    below is the link.

    http://tomahawksurvival.com/2009/12/25/hot-dogs-tortillas-and-a-broken-ankle-in-the-chiricahua-mountains/

    tomahawk
    [img]http://www.deathvalleymag.com/wp-content/uploads/2010/03/Chiricahuas 040.jpg[/img]

      (Quote This Comment)

  2. I thought you tripped over you walker or cane Tomahawk – lol

    Great article, hurting my ankle is the probably the only injury I have ever had regardless if I was toting a gun or just walking home from a bar

    Come to think of it, bars and injuries seem to go hand-and-hand for me

    ~James G

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  3. Damn!!!! Good article,horrific ijury photo, and very appropriate, and better yet, written in a way that the average guy ( or gal) can make sense of it.

    I actually worked in the orthotic and prosthetic field for a number of years, and IMHO, feet and lower legs are the weak link and most neglected part of the anatomy. If a person has a wound, or a fracture, impaired or bad circulation ( either from a disease like diabetes or from trauma) it can at the least sideline him or if untreated, take him out.

    I once had a diagram, BTW, on one of those ‘pass around Xerox’ things that were big back in history, which showed how to use a knife – Kabar or whatever you had – to remove the sole of an extra boot ( volunteered by a deceased enemy) and make the UPPER of the boot and laces into a combat-improvised ankle / foot immobilizer, not as good as a cast but enough to minimize motion and pain while trying to help a bud get out of harm’s way.

    Anyway – great articles, People need to know this type of thing, whether in another place as an operator or ‘advisor’, or walking through a forest or a backpacking trail. Keep up the good work.

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  4. That’s the thing I like most about John B’s articles – they are written from the perspective of someone with limited medical knowledge (like me).

    ~James G

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  5. I thought you tripped over you walker or cane Tomahawk – lolGreat article, hurting my ankle is the probably the only injury I have ever had regardless if I was toting a gun or just walking home from a bar Come to think of it, bars and injuries seem to go hand-and-hand for me ~James G  (Quote This Comment)

    I actually slipped on a banana peel outside of the old folks home.

    tomahawk

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  6. That’s the thing I like most about John B’s articles – they are written from the perspective of someone with limited medical knowledge (like me).~James G  (Quote This Comment)

    I thought your medical knowledge included exrensive experience in amature gynacology and pharmacology.

    tomahawk

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    1. Roger that on gynecology

      ~James G

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  7. I’ll be adding this rule as QR card in my kit when I build it…Very well written and informative – Thanks!

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  8. Great info. I\’m not in some enemy area, just spend a lot of time tripping around over downed trees where a problem means I\’m all there is since it\’s so remote (and no cell phone towers even if I had a cell phone).
    Anything from John B is always welcome.

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    Weight loss does not have to become difficult and your exercise routine
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