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Outdoor First Aid

Here’s How to Tell When Your Sprained Ankle Requires a Trip to the Hospital

In the backcountry, a twisted ankle can spell trouble. Learn how to tell minor sprains from major injuries, and what to do if you’re hurt.

There I was, enjoying a short trail run in the local woods, absentmindedly listening to seventies classic rock. Then I took one slippery step on a wet root, and my right ankle twisted violently. My foot turned inward, stretching my anterior talofibular ligament way farther than it’s built to stretch. 

I hobbled along for a few steps before resuming a slow jog. But the injury was uncomfortable enough to make me wonder whether I could get strong enough to hump a heavy pack during a Cascades hiking trip I had planned later in the month. 

Chances are good you’ve been in a similar situation: Twisted ankles are one of the most common injuries in backpacking. Step wrong, and the consequences can be anything from an uncomfortable day on the couch to, in rare cases, a trip to the OR.

Most ankle sprains are inversion injuries, meaning that the big-toe side of the foot twists inward, and the ligaments on the outside of the ankle bear most of the stress. The ligaments that connect the fibula—one of the two bones in your lower leg—to the talus bone in your hindfoot are usually involved. The damage can range from a slight stretch to a complete rupture of one or more ligaments that keep the ankle stable.

I was lucky to finish my run without much pain. But if you’re hours from the trailhead and find yourself unable to bear weight on an ankle, it’s time to call for help. Try improvising a splint and walking with the aid of a companion. If the pain prohibits you from getting out on your own power, you may need to spend an unexpected night out (hopefully, you’ve packed a shelter, or at least a survival blanket).

Once you’re out, the rehab begins. After the initial pain and swelling have improved, all but the most severe sprains likely benefit from early range of motion and weight-bearing exercises. Think about moving the ankle in circles, or practicing the motion of stepping on the gas and then letting up. Better yet, imagine sitting in a beach chair, spelling the alphabet in the sand with your big toe. Unfortunately, the most serious sprains—when you can’t walk at all immediately after the injury—require further evaluation from a medical professional to make sure that nothing’s broken, and possibly a period of immobilization before starting rehab. 

Christopher Tedeschi teaches and writes about wilderness and disaster medicine. He is associate professor of emergency medicine at Columbia University and an editorial board member for the journal Wilderness and Environmental Medicine. He enjoys hiking and biking near his home in the lower Hudson Valley. 

Dealing With Ankle Sprains: The Skills

The best way to treat an ankle sprain: prevent it. Work these ankle-strengthening exercises into your routine and build up the leg and foot muscles you need to keep your ankles stable.

For more major injuries, you may need to immobilize the ankle before you start to hobble out. Learn how to improvise an ankle brace with common supplies you’ll have in the backcountry.

Another good way to prevent ankle sprains? Double down on support. Find our favorite picks for mid-top hiking boots in our annual footwear roundup.

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