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Ottawa ankle rule (Stiell 1992). Ankle x-ray is indicated when there is malleolar-zone pain and any of: bone tenderness at the posterior edge or tip of the lateral or medial malleolus, or inability to bear weight both immediately after injury and in the emergency department (four steps). One weight-bearing failure alone is not enough. Not a diagnosis of fracture, not the Ottawa foot rule, and not the Pittsburgh knee rule. magent does not examine the ankle.