In the Ottawa ankle rules, tenderness over which area necessitates an X-ray?

In the Ottawa ankle rules, tenderness over the distal fibula is used as a criterion to determine the need for an X-ray. The purpose of these rules is to identify patients who may have an ankle fracture and therefore should undergo imaging to confirm or rule out a fracture.

Tenderness at the distal fibula indicates a potential fracture in that area, as it is a common site for injuries related to ankle sprains. The Ottawa ankle rules specifically state that if a patient has pain at the malleolus (the bony prominence on either side of the ankle) combined with tenderness over the distal fibula, an X-ray is warranted.

In contrast, tenderness over the proximal fibula, distal femur, or midfoot are not parts of the Ottawa ankle rules related to evaluating ankle injuries in this manner. Each of those areas corresponds to different types of injuries or may follow other specific guidelines for assessment. Therefore, recognizing tenderness over the distal fibula as a key indicator aligns with the structured approach of the Ottawa ankle rules in determining the necessity for X-ray imaging following an ankle injury.