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The authors declare that there is no conflict of interests.""Injury of the ankle joint is common with an annual incidence of ankle fractures is 122 per 100000 Erastin people (1). The acute trauma of this joint is one of the main reasons for visits to Emergency Department (ED). It is estimated that only about 15% of these patients have fracture (2). In most hospitals, it is a common practice to request radiographs of ankle and/or foot although 85% of the examinations prove negative for presence of fractures (2). To reduce the number of unnecessary ankle and foot radiographs, Stiell et al. from Canada developed a set of rules for obtaining radiographs called Ottawa Ankle Rules (OARs) (3). Ottawa ankle rules are based on the objective criteria that reduce the subjective component of the clinical evaluation, providing specific indications for radiographs and allowing reduction in hospital costs, the exposure to ionizing radiation, and the waiting buy 3-deazaneplanocin A time in emergencies. According to these guidelines, radiographs of the ankle joint are recommended only if there is any pain in the malleolar zone and any one of the followings: bone tenderness along the distal 6 cm of the posterior edge of the tibia or tip of the medial malleolus; bone tenderness along the distal 6 cm of the posterior edge of the fibula or tip of the lateral malleolus; or an inability to bear weight both immediately and in the ED for four steps. The Ottawa foot rules are for assessing whether a foot X-ray series is indicated. It states that they are indicated if there is any pain in the midfoot zone and any one of the followings: bone tenderness at the base of the fifth metatarsal (for foot injuries); bone tenderness at the navicular bone (for foot injuries); or an inability to bear weight both immediately and in the ED for four steps 2. Objectives Several attempts have been made to validate the OARs in different countries. Our goal for this study is to provide the evidence for the use of the OARs as a method for the prediction of significant fractures in an Indian clinical setting. 3. Patients and Methods This prospective study was conducted in the ED of a teaching hospital in North India over the nine months from February to November Ro3280 2011. We included all patients who had sustained ankle and/or midfoot injury with less than 24 hours of injury. All patients were clinically examined by an orthopedic surgeon. We excluded patients with multiple trauma, pregnant woman, patients with altered level of consciousness (Glasgow coma scale