Acute ankle injuries are extremely common in the emergency department, and the receiving physician will have most patients undergo an x-ray to diagnose an ankle fracture, while the dominant injury, the collateral ligament injury of the ankle, does not require an x-ray. Therefore, the overuse of foot and ankle X-rays violates the principles of imaging and reduces the efficiency of the physician. At the same time, in the absence of X-ray examination, physicians need to make a preliminary judgment on whether a fracture has occurred in order to make the next treatment plan. When the pain in the ankle area is accompanied by one of the following indications, X-ray examination is required: 1. 6 cm of bone pressure at the tip of the outer ankle or distal fibula; 2. 6 cm of bone pressure at the tip of the inner ankle or distal tibia; 3. inability to walk with full weight bearing. X-rays should be performed when there is pain in the midfoot area with one of the following indications: 1) bone compression at the base of the fifth metatarsal; 2) bone compression in the navicular bone; 3) inability to walk with full weight bearing. The Ottawa guidelines should be applied with the following points in mind: 1. Palpate the tibia and fibula from the proximal to the distal end to check for bone compression pain; 2. The following conditions are given priority for clinical judgment: 1. difficulty in communication or non-cooperation with the examination, such as in alcoholics; 2. painful injury with other sites; 3. diminished sensory function of the leg; 4. significant swelling.