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Possibly the most common injury I see when hiking with groups is when someone turns or rolls their ankle. Assuming that access to a vehicle is not feasible, what is the best way to deal with the injury to make it several miles out without causing further damage to the joint?

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  • This happened to me, 6.5 miles from civilization. Laid me up for six days (fortunately at the NOC, a nice place to be laid up). I recommend prevention: use hiking poles!
    – Michael Hampton
    Oct 26, 2013 at 4:27

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There are relatively well known steps to dealing with this out in the wilds. One online resource with pictures is at Backpacker Magazine.

The basic steps (that are detailed there) are:

  • Rest, Ice, Compression and Elevation (which you should do with any sprain, wherever you are)
  • Bandage reasonably tightly - not so tight that you cut off circulation, but tight enough that you restrict swelling and support the ankle. A visual check to make sure the toes aren't turning blue is essential, especially in a very cold environment!
  • Pad the ankle - a scarf, t-shirt or other material helps to make sure the ankle bones are protected.
  • While you can use a branch, a much better option, and the one Backpacker Magazine recommends, is to use a foam sleeping mat as a splint, as it provides support and some impact protection. You can fold it in half, place it down one side of the leg, under the foot and up the other side. If it is too big, cut it - you can always buy another one once you get home. Use your usual mat ties or straps to hold it tight.
  • Once you have got it secure and the ankle is immobilised without it being too tight, and you are confident that it won't be damaged further, take ibuprofen to help kill the pain and reduce inflammation.
  • Support the individual and slowly walk back to civilisation.
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    Question on the order of operations. Is there a particular reason to do all the securing before taking the ibuprofen? Why not use the anti-inflammatory before manipulating the injury?
    – Russell Steen
    Oct 17, 2012 at 12:49
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    Pain can be very useful until you are definite what the issue is. What appears to be a sprain could be a break - leaving the painkiller until a bit later helps you avoid accidentally numbing the pain too much and damaging a broken ankle. Although, as ibuprofen takes 20 minutes to kick in, this could be done earlier.
    – Rory Alsop ♦
    Oct 17, 2012 at 13:13
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    The modified mnemonic taught these days for soft-tissue injury is IRICE -- Ibuprofen, Rest, Ice, Compression, Elevation. The painkiller in Ibu is not sufficient to mask (and thus miss) critical pain, but the sooner you can get the anti-inflammatory in you the better.
    – Lost
    Oct 19, 2012 at 13:54
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    Oooh - that's interesting, and makes sense (see my 20 minutes comment.) I was always told to wait on the Ibu until you had made a definite diagnosis (but this was from a nurse, so her standards may be more technical than the practical outdoors usage). Is IRICE commonly accepted? If so, I'll update the answer.
    – Rory Alsop ♦
    Oct 19, 2012 at 14:51
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    I was recently involved in an incident in the Lake District with an ankle injury, and the Langdale Mountain Rescue first responder used a mix of Paracetamol and Codeine as the pain killer. This was also the combination used after surgery and for aftercare at different hospitals. Seems to be the standard in the UK. Codeine requires a GP prescription, but you could probably talk them into it if you explain it's for your emergency kit.
    – Tullochgorum
    Jun 10, 2017 at 13:31
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I was once the rather unhappy participant in a study on ankle injury treatment at the Edinburgh Royal Infirmary.

I came in with a serious injury and was told that with conventional treatment I would have been immobilised for weeks.

What they did was plunge my ankle in ice for as long as it was bearable, and once the swelling had reduced, they manipulated my foot in all directions to drive bloodflow into the injury. Then they moved me onto a wobble-board, and finally had me jumping over a bench! I walked out of there with only a slight limp.

They said that this rather basic treatment was hugely out-performing any other approach they had studied, including bleeding edge high-tech techniques.

Of course before they did this they had taken an X-Ray to check for a break. In the back-country you'd have to proceed with caution. Although the treatment was uncomfortable, it was pretty clear that I didn't have any kind of serious break. Just use common-sense and stop if the movement causes significant pain.

Some time after this experience I came across a guy in trouble high in the Alps. His ankle was so swollen that he couldn't get his boot back on, and he was a long way from safety. I got him to plunge his foot into a handy glacial stream, and the swelling was much reduced. I gingerly manipulated his foot, and he was pretty confident there wasn't a break. After 20 or 30 minutes of working through the protocol he was quite mobile again. He was able to get back into his boot, and he and his party set off for the valley in good spirits.

Worth a try, I think, in extremis.

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