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April 1998

Sprained Ankle Relations

How to keep hiking when your ankle takes a turn for the worse. Plus, keeping them strong and trail-ready.

Here’s one you can probably relate to: The sun’s about to set and you’re scrambling for the best seat to catch the show. Exhilarated by the impending beauty, you run, you leap, you crash. Tweak goes the ankle. As the sky fills with hues of pink and orange, your ankle turns shades of blue and purple. The pain is so bad you can barely limp back to camp.

Or maybe you’re crossing a stream and slip on a rock or encounter a big root across the trail or aren’t paying attention on a downhill switchback-there are so many ways to harm the joint that connects foot to leg that ankle sprains account for almost 53 percent of injury-related evacuations from National Outdoor Leadership School (NOLS) courses.

The good news is that most sprains can be managed in the field. Even better is the fact that for the ankle-aware, such painful calamities are largely preventable.


The two big bones in your lower leg, the tibia and fibula, meet your ankle at the talus bone, which sits atop the calcaneus, or heel bone. A complex arrangement of ligaments holds it all together, and under normal conditions the ankle can withstand some eversion (turning outward) and inversion (turning inward). When an ankle goes too far one way or the other, a sprain results. In severe cases-during a leap, or when plunging downhill under a load, for instance-the tib and fib can be forced apart and ligaments are torn, which causes excruciating pain.

Whether you’re the injured one or you’re trying to help someone else with a bum ankle, assessing severity is relatively simple. Which way did the ankle twist? Was there force involved? Was there a “popping” or “snapping” sound? Has the ankle been injured before?

Now study the ankle. Is there swelling or discoloration? How much? Is there pain when you press on the ligaments, tendons, bones? Tenderness means injury. Carefully move the ankle through its range of motion. Again, is there pain?

As with most traumatic injuries, ankle sprains have three levels:

  • A first-degree injury, the most common type, occurs when ligaments stretch but don’t actually tear. Moving your foot and the damaged ligaments causes pain, but there’s little swelling, bruising, or instability. With proper care and taping you can keep hiking and will be back to normal in one to two weeks.
  • With a second-degree injury, partially torn ligaments quickly swell and cause bruising. The pain may discourage you from moving your foot, and complete healing can take as long as six weeks. A moderately injured ankle can also be taped, but only so the person can limp back to the trailhead, with most of the weight from his backpack distributed among other group members. Walking will be difficult but tolerable.
  • Third-degree injuries involve complete ligament tears. Bruising may be extreme and within 30 minutes of the injury you won’t be able to move your foot because of the intense pain and swelling. An ankle that’s injured this severely can be confused easily with one that’s broken (symptoms can include a “pop” or “snap” when the injury occurred, persistent intense pain, tenderness when touched, and an obvious deformity). Whether it’s a third-degree sprain or a break, the injury requires splinting and immediate medical attention. Third-degree sprains can take six months or longer to completely heal, and 10 to 15 percent of those afflicted may require rehabilitative surgery.

To reduce pain and swelling, all ankle injuries should initially be managed with RICE:

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