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Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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Turning an Ankle

By Paul S. Auerbach, MD | Published Jul 3, 2006

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The July 4th weekend is a great chance to get outside and work on conditioning. I was hoping for a great jog on the trails around Folsom Lake, but was stymied by something that happens to me every couple of years, even when I’m paying attention. Running downhill on a narrow path, I stepped on a softball-sized rock protruding from the hard ground, and twisted my left ankle. It was the classic turn, inverting my foot (inward rotation) and “rolling” over the outside of my foot. I heard the all-too-familiar crunch and felt the small ligaments tear, with immediate pain on both the outside and inside of my ankle. I still had two miles to go to get back to my starting point. It was slow going, but I continued, because I knew that the pain would grow worse and the pain increase within the hour.

No doubt, I nailed my anterior inferior tibiofibular and anterior talofibular ligaments, which help anchor the bones of my ankle in place. These are the most commonly injured, but there are seven other ligaments in the ankle complex that might have also been strained.

The immediate therapy is RICE: rest, ice, compression and elevation. As soon as I could, I iced my ankle, using a bag of frozen edamame (soy beans) from Trader Joe’s. I was off to watch my son play baseball, so I carried a bag of ice to apply off and on for the next few hours. Still, it turns out that I have a fair amount of swelling, so it will be a couple of weeks at least before I can test my ankle jogging again.

To complete the therapeutic advice, for the next two days, I will wear a walking splint (left over from an ankle fracture/dislocation four years ago – but that’s another story) for a couple of days so that I can work in the E.R., then begin using intermittent heat applications to assist in comfort and resolution of the swelling. Most of all, I need to be patient, because ligaments take weeks to heal, and it’s important that they heal “tight and strong.”