You’d typically only need an X-ray after an ankle sprain if there’s a suspicion of a fracture—and that’s where the Ottawa Ankle Rules come in. These are widely used clinical guidelines to decide if imaging is necessary. You’d likely need an X-ray if:
✅ According to the Ottawa Ankle Rules, get an X-ray if there is:
- Bone tenderness at the posterior edge or tip of the lateral malleolus (outer ankle).
- Bone tenderness at the posterior edge or tip of the medial malleolus (inner ankle).
- Inability to bear weight both immediately after the injury and in the clinic (can’t take four steps).
💥 If there’s tenderness over the base of the 5th metatarsal (outside of the foot) or the navicular bone (inside midfoot), a foot X-ray might be needed too.
🚩 Other red flags that might prompt imaging:
- Severe swelling or bruising
- Gross deformity
- Hearing a crack/pop at the time of injury
- History of osteoporosis or previous fracture in the area
- Pain that doesn’t improve within 5–7 days despite rest and offloading
If it’s a mild to moderate sprain, you can usually manage it with RICE (Rest, Ice, Compression, Elevation), physio, and gradual return to weight-bearing. But if you’re unsure or if symptoms don’t improve, it’s worth checking in with a physio or GP—especially to rule out things like avulsion fractures that can mimic a sprain.