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?
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.
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.