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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.

REST the injury; in other words, make the person get off his feet.

ICE the ankle; cool it with packed snow, soak it in a cold mountain stream, or wrap it in a wet T-shirt.

COMPRESS the injury with an elastic wrap (if available) to reduce swelling, working from the toes toward the heart. Never wrap so tightly that circulation is impaired and the injured person loses feeling in the toes.

ELEVATE; prop the leg up higher than the person’s heart.

Maintain RICE for 20 to 30 minutes, then allow the injured ankle to rewarm for 12 to 15 minutes before letting the person try to use it. RICE may be repeated every 2 to 4 hours for the first 24 hours. Over the next 48 hours you’ll want to maintain compression and apply ice three to four times a day. Doctors typically recommend an anti-inflammatory/pain-killing drug, such as ibuprofen, for sprains and tendonitis.

To help speed recovery most physicians now recommend that patients use a sprained ankle as soon as possible, depending on the severity of the injury. It may be a day or two, however, before the person is willing to walk very far, and of course, the injured person is the one who should ultimately determine if an ankle is usable.

If you prefer the preventative approach, there are several things you can do to forestall an ankle injury:

  • Strengthen muscles: The best way to prevent injury is to get in shape by running, cycling, and swimming-preferably with fins-to help strengthen ankles.
  • Lose weight: Excess pounds put stress on your ankles.
  • Wear good boots: Choose stiff footwear that provides adequate ankle support, and replace soft, worn-out boots.
  • Warm up muscles: Before shouldering a pack, put your hands on a tree and lean against it with one leg forward, one leg back. Lock the back knee, and flex the front knee. Press forward until you feel a stretch in the calf muscle (it attaches to the Achilles tendon) of your back leg. Now keep both heels on the ground and bend both knees until you feel more stretching in the lower leg muscles. Hold for 15 to 30 seconds. Repeat with your other leg back. Walk around packless to warm up all leg muscles.
  • Learn from the past: If you’ve suffered a prior ankle injury, follow the first four suggestions even more aggressively.
  • Don’t be careless: Avoid becoming rushed, don’t hike after dark, and always watch where you place your feet when hiking.


When your feet and ankles move, so do the lower leg muscles and tendons, which are the fibrous tissues connecting muscle to bone. If you’re not in the best shape and try to hike too far too soon, inflammation of tendons can result. Tendonitis can range from discomfort to debilitation, depending on the degree of inflammation.

Achilles tendonitis can occur after a long hike, especially when significant elevation gain is involved, because the lower the heel is in relation to the toes, the greater the stress on the Achilles. Your boots can also be the cause. An inward fold above the heel counter can irritate the Achilles enough to cause tendonitis after just one day of backpacking. Broken down or poor-quality boots that allow too much motion and not enough support may lead to pain and inflammation. Similarly, footwear that’s too stiff or too tightly laced can result in tendonitis at the front of the ankle.

Treatment includes placing a quarter-inch-thick pad under your heel to relieve stress on the Achilles. A strip of padding-small pieces of a closed-cell foam sleeping pad or folded gauze will do-taped on each side of the Achilles will further reduce stress. As a general rule, placing padding on both sides of any injured tendon will reduce stress and discomfort.

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