Purpose Ankle and foot injuries are one of the most common acute sport injuries. The objective was to conduct a study to determine the accuracy of the Ottawa Ankle Rules (OARs) to rule out ankle and midfoot fractures in athletes' population presenting with blunt ankle and midfoot injuries.

Methods Two physicians assessed the OARs in 1156 athletes and 1329 radiographs. Radiography was performed in each patient after clinical evaluation. Findings were recorded. An expert radiologist who was blinded to clinical exanimation interpreted the radiographs.

Findings Of the 1329 radiographs from ankle and midfoot trauma, 93 ankle and 71 midfoot fractures were diagnosed. All cases with a fracture had a positive OARs result (sensitivity 100% 95% CI; 97–100) and of 1165 radiographs without a fracture, the OARs were negative in 439 cases (specificity 37%; 34–40).The corresponding potential savings in radiographs was 33% using the OAR. The interobserver agreement for our two independent assessors was substantial. (κ=0.79, SE=0.11).

Conclusion This validation study of the OARs in an Iranian athletes' population produced similar results than those published previously in various other settings. We confirmed the previous studies that the OARs could be a reliable tool to exclude fractures and could aid sport medicine physicians make proper decisions on field and in clinic about athletes who suffered from ankle and midfoot trauma. Employing OARs would significantly decrease radiography requests and costs.