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Less than a decade ago, clinical epidemiologist Ian Stiell, working with emergency department physicians, formulated the Ottawa Ankle Rules.1 The local climate was highly conducive to slips and falls. The rules are intended to guide clinical decisions about the efficient use of radiography in the diagnosis of malleolar zone fractures and midfoot zone fractures, minimising expenditure, unnecessary exposure to ionising radiation and emergency department waiting times for patients. In summary, they state that radiographic examination is not required unless, in the first instance, there is tenderness at the posterior edge or tip of the medial or lateral malleolus, or in the latter instance over the navicular bone or base of the fifth metatarsal. The rules leave fractures of the talus as an intrinsic “blind …
Conflicts of interest: none.