Exam by body system

How to examine the ankle and foot (Ottawa rules)

Other platforms explain it with text and video. In VMS you practice it on the patient.

MD / DOPAEMS (NREMT)
Practice it in VR with Blocky

The Ottawa ankle rules help decide who needs an X-ray after an ankle injury.

Step by step

  1. Look

    Swelling, bruising, deformity. [1]

  2. Feel the key points

    Back edge and tip of both malleoli (6 cm), base of the fifth metatarsal, navicular. [2]

  3. Ottawa ankle rules

    X-ray if bone tenderness at those points or cannot take four steps right after the injury and in the clinic. [2]

  4. Move

    Up, down, in, out. [1]

  5. Stability

    Anterior drawer for ligament injury. [1]

  6. Pulses and nerves

    Dorsalis pedis, posterior tibial, sensation. [1]

  7. Achilles

    Thompson test: squeeze the calf, the foot should point down. [1]

Common errors

Practice it in VMS

In VMS you do this on the patient, not on paper: every step goes on the checklist with a score, and in Teach mode Blocky tells you what comes next.

VMS cases that train this skill

16 VMS cases train this skill: open the case library

Sources

  1. Stanford Medicine 25 (bedside exam)
  2. NCCPA PANCE Content Blueprint
  3. Open RN, Nursing Skills 2e (Chippewa Valley Technical College) (CC BY 4.0)

Steps adapted from Open RN, Nursing Skills 2e (Chippewa Valley Technical College), licensed under CC BY 4.0. Facts and steps also follow NCCPA PANCE Content Blueprint; Stanford Medicine 25 (bedside exam). VMS is not affiliated with these organizations. Updated: 2026-10-11.