II. Technique: Views

  1. Lateral ankle
  2. Anteroposterior ankle
  3. Ankle Mortis view
    1. Anteroposterior view
    2. Leg internally rotated 15 to 20 degrees

III. Indications: Ottawa Ankle Rules in Acute Ankle Sprain

  1. Ankle XRay not needed if both are true:
    1. Able to ambulate at injury or in ER for 4 steps
    2. No pain over distal posterior 6 cm (2.4 inches) of tibia, fibula
  2. Foot Xray not needed for mid-Foot Pain if both true:
    1. Able to ambulate at injury or in ER for 4 steps
    2. No pain at fifth Metatarsal base and Tarsal Navicular
  3. Efficacy
    1. Test Sensitivity for Malleolar Fracture: 95%
    2. Requires alert adult or child age 5 or older
    3. Injury within prior 10 days

IV. Imaging: Pitfalls

  1. Growth Plate Fracture in adolescent
    1. May be missed on Ankle XRay
    2. Consider if pain over lateral malleolus (fibula)
  2. Ankle Syndesmotic Sprain (High Ankle Sprain)
    1. Tibiofibular clear space widening >6 mm
  3. Ankle mortise
    1. Space around the talus should be consistent (symmetric) at its margin between the tibia and fibula
  4. Os Trigonum is a normal variant (lateral xray)
    1. Os Trigonum is an Ossification Center posterior to the talus
    2. Normal variant seen on lateral Ankle XRay in up to 14% of patients


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Ontology: Radiography of ankle (C0203281)

Concepts Diagnostic Procedure (T060)
ICD10 57518-03
SnomedCT 145829004, 19490002
CPT 73600, 73610
English Radiography of ankle, x-ray of ankle, x-ray of ankle (procedure), X-ray;ankle, X-ray of ankle, Ankle X-ray (procedure), Ankle X-ray, Radiography of ankle (procedure), Radiography of ankle, NOS, X-ray of the ankle
Spanish radiografía de tobillo (procedimiento), radiografía de tobillo