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Backpacker Magazine – December 2007

Survive a Mangled Ankle

Help yourself hike out after an ankle injury

by: Tom Wilmes

Predicament: You're crossing a steep talus field when a rock shifts, folding your ankle like flimsy tent stake. You hobble over to a boulder as your foot begins to throb.

Lifeline: Loosen your boot, but don't remove it (swelling could make it hard to put back on). Test your ankle. If it can't bear weight, you feel severe stabbing pains, and you heard a "pop" when it twisted, you have a fracture or severed ligaments. Improvise a splint with a rolled sleeping pad, clothing, and straps, then evacuate to the nearest road. If the pain is manageable, you're probably facing a bad sprain (stretched or partially torn ligaments). Apply a water bladder or zip-top bag filled with cool water or snow as soon as possible to limit inflammation and speed healing. After 30 minutes, wrap your foot by threading an ACE bandage under your arch and around your ankle in a figure-8 pattern. Tie your boot as tight as you can stand it, and try walking. Offload gear to lighten your backpack, and make a crutch by wrapping a t-shirt over a pole. Your routine until you reach the nearest trailhead is RICE: rest, ice, compression, and elevation. Stop every hour to elevate and cool your ankle. Take ibuprofen to reduce pain and inflammation.

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Mar 06, 2011

I agree with Kerry and Ed, and would like to add that ibuprofen should never be given to someone with a recent joint injury. Ibuprofen is an anticoagulant and can inhibit the formation of clots around an injury site, leading to increased swelling, bruising, and pain, especially in a joint injury.

If readers are looking for a more reliable source of backcountry medical information, I suggest the various textbooks produced by WMI, WMA, and SOLO.

Jan 20, 2011

Hey gang. You know this article is clearly intended for an injury that occurs while deep in the woods. Just last year I was coming down Mt. Marcy--the highest peak in the Adirondacks. It was a very cold, snowy and icy early spring day. Upond descending the monolith, I tripped on a very small tree root, and I snapped my right ankle. Of course I had no idea of the extent of the dammage--looking back I'm glad I had no idea. If I were to have removed the boot, I guarantee you I would never have gotten it back on. I clumsily fashioned a walking stick, I hiked for 7 miles with what ended up being a broken bone in my ankle and tibia. Not to mention the tons of ligament dammage that occured as well. I ended up having two surgeries, 8 months of lying on my back and 4 months of intense physical therapy before I could even think about walking right again. The funny thing is I thought it was a bad sprain becuase I could move my foot and I could feel my toes and because I wasn't in the worst pain imagineable. I was so convinced of it because how else could I have hiked for so long with two broken bones in my ankle and leg? Well, the body always strives to survive. If I stopped to rest for too long, or if I tried to analyze what had happened to me, I know that I would have died from the freezing cold first, but my body would have relaxed too much and I don't think I would have been able to move on.

Jan 17, 2011

Normally the boot should come off right away, but I believe the idea behind the articles comment is that if you are in a situation where you need to walk, say if you are day hiking somewhere and aren't prepared to stay overnight, or hiking somewhere that you can't set camp. Or any number of reasons where it would be bad to be stuck where you are until swelling goes down

Sep 06, 2010

I agree with Kerry. This article is wrong. This is what is should say to some degree:
First, figure out what king of injury is it. A simple sprain or is it serious(broken). If simple sprain, take off boot and apply RICE immediately. Rest Ice Compression Elevation for at least 30 min. Then try to walk on it.
If severe injury, first RICE. Then take a look at your options: your location, your gear, food and water amounts. All of these things will dictate your next action: Sit and wait for help or try to get out with makeshift crutches.
That is my piece of mind.

Sep 06, 2010

Kerry Scott
Sep 03, 2010

These instructions seem to have a built-in contradiction. Almost none of the good advice about cooling to reduce swelling and wrapping with an Ace bandage, etc. are possible with the boot still on. The boot should come off early on, followed by the good advice otherwise offered.


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