Firstly if there is pain located near the malleolus (outside of ankle bony prominence) and there is one or more of the following:
1. Bone tenderness along the distal 6 cm of the posterior edge of the tibia or tip of the medial malleolus
2. Bone tenderness along the distal 6 cm of the posterior edge of the fibula or tip of the lateral malleolus
3. Inability to bear weight for 4 steps, both immediately after the injury and in the emergency department
Or, secondly if there is pain located at the midfoot and one or more of the following:
1. Bone tenderness at the base of the fifth metatarsal
2. Bone tenderness at the Navicular bone (inside border of the foot)
3. Inability to bear weight for 4 steps, both immediately after the injury and in the emergency department