Leiden ankle rulesUtrecht ankle rules
Weight bearing*3Weight bearing/axial compression*2
Pulseless/weak posterior tibial artery†2Pain on palpation/swelling
Pain and palpation malleoli/metatarsal V‡2Pain on palpation/swelling
Swelling malleoli/metatarsal V2 Tibia1
Swelling/pain in Achilles tendon1 Fibula1
Age divided by 10 Achilles tendon1
Radiographs required if>7 Base of fifth metatarsal1
Sensitivity 88%; specificity 57%Haematoma/haemarthrosis1
Age divided by 10
Radiographs required if≥8
Sensitivity 59%; specificity 84%
  • *Inability to bear weight was defined as the inability to walk four steps. Axial compression pain was defined as pain on application of axial compression.

  • †Positive in case of a marked difference with the contralateral side.

  • ‡Of the posterior edge (6 cm) of both the lateral and the inability to walk four steps. Axial and medial malleolus and the base of the fifth metatarsal bone.

  • NPV, negative predictive value; PPV, positive predictive value.