 Introduction/Background Acute injuries to the foot are frequently encountered in the setting of the emergency room and in general practice. The clinical indications for imaging (known as the Ottawa rules) have been developed to minimize unnecessary radiographs, and their utility is well documented by multiple studies. The most commonly accepted form of these rules is the following: A series of foot radiographs is required only if there is pain in the midfoot and any one of the following: 1) point bone tenderness of the navicular; 2) point bone tenderness of the base of the fifth metatarsal; or 3) inability to bear weight or to walk 4 steps (immediately after the injury or at the emergency department). A meta-analysis (10 studies encompassing 3,725 patients) of the Ottawa rules for the foot showed that these rules have a sensitivity of 99% and a median specificity of 26% for combined evaluation of the ankle and midfoot [1]. The Ottawa rules for the ankle and midfoot have been shown to be effective for the pediatric population (>5 years of age) [2]. Including the added criterion of swelling yields a sensitivity and specificity for fracture of 100% and 55% for the malleolar zone and 50% and 40% for the midfoot, respectively [3,4]. Exclusionary Criteria Multiple conditions or scenarios preclude the use of the Ottawa rules for determining if imaging is necessary [5,6]. It has been reported that the Ottawa rules for the foot should not be used or should be used with great caution in the following clinical situations: penetrating trauma, pregnancy, any skin wound, transferred with radiographs already taken, >10 days after trauma, a return visit for continued traumatic foot pain, in the setting of polytrauma, altered sensorium, neurologic abnormality affecting the foot, or underlying bone disease [7].
Acute Trauma to the Foot.  Introduction/Background Acute injuries to the foot are frequently encountered in the setting of the emergency room and in general practice. The clinical indications for imaging (known as the Ottawa rules) have been developed to minimize unnecessary radiographs, and their utility is well documented by multiple studies. The most commonly accepted form of these rules is the following: A series of foot radiographs is required only if there is pain in the midfoot and any one of the following: 1) point bone tenderness of the navicular; 2) point bone tenderness of the base of the fifth metatarsal; or 3) inability to bear weight or to walk 4 steps (immediately after the injury or at the emergency department). A meta-analysis (10 studies encompassing 3,725 patients) of the Ottawa rules for the foot showed that these rules have a sensitivity of 99% and a median specificity of 26% for combined evaluation of the ankle and midfoot [1]. The Ottawa rules for the ankle and midfoot have been shown to be effective for the pediatric population (>5 years of age) [2]. Including the added criterion of swelling yields a sensitivity and specificity for fracture of 100% and 55% for the malleolar zone and 50% and 40% for the midfoot, respectively [3,4]. Exclusionary Criteria Multiple conditions or scenarios preclude the use of the Ottawa rules for determining if imaging is necessary [5,6]. It has been reported that the Ottawa rules for the foot should not be used or should be used with great caution in the following clinical situations: penetrating trauma, pregnancy, any skin wound, transferred with radiographs already taken, >10 days after trauma, a return visit for continued traumatic foot pain, in the setting of polytrauma, altered sensorium, neurologic abnormality affecting the foot, or underlying bone disease [7].