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Ankle sprain assessment template

Applies the Ottawa ankle and foot rules before anything else, grades the injury and sets return-to-sport goals.

What it is built on

  • X-ray decision. Ottawa ankle rules (Stiell et al., 1992; refined 1993)
  • Management and prevention of recurrence. Clinical practice guideline update for ankle sprain (Vuurberg et al., British Journal of Sports Medicine, 2018)

How to use it: Free Evidence-Based Physiotherapy Note Templates

Subjective

  1. History of the presenting problem Written answer Onset, mechanism, duration, behaviour over 24 hours, aggravating and easing factors.
  2. Pain now (0–10) Scale 0 to 10
  3. Pain at worst in the last week (0–10) Scale 0 to 10
  4. What it stops them doing Written answer Work, sleep, sport, daily tasks.
  5. Patient's goals Written answer In their words.
  6. Previous sprains on this side Choose one: None · Once · Twice · Three or more

Ottawa ankle and foot rules

  1. X-ray is indicated if there is pain in the ankle or midfoot zone and any of the following
  2. Bone tenderness at the posterior edge or tip of the lateral malleolus (distal 6 cm) Tick box
  3. Bone tenderness at the posterior edge or tip of the medial malleolus (distal 6 cm) Tick box
  4. Bone tenderness at the base of the fifth metatarsal Tick box
  5. Bone tenderness at the navicular Tick box
  6. Unable to take four steps, both straight after the injury and now Tick box
  7. Result Choose one: No X-ray indicated · X-ray indicated — referred to GP or emergency

Objective

  1. Swelling and bruising Written answer
  2. Range of movement and weight-bearing Written answer
  3. Ligament tests Written answer Anterior drawer, talar tilt, squeeze and external rotation tests for the syndesmosis.
  4. Balance Written answer Single-leg stance, eyes open and closed.
  5. Grade Choose one: I — mild · II — moderate · III — complete tear · Possible syndesmosis (high ankle) injury

Plan

  1. Clinical impression Written answer
  2. What was explained to the patient Written answer
  3. Treatment today Written answer
  4. Home program given Written answer
  5. Plan and expected number of visits Written answer
  6. Referral or imaging needed? Choose one: No · Yes — to GP · Yes — imaging · Yes — specialist · Yes — urgent / emergency
  7. Return to sport or work goal Written answer Exercise-based rehabilitation including balance work reduces re-injury.

A starting point, not clinical advice. Check that it fits your patients, your practice and the rules where you work before you use it.