7/28 Wilderness Medicine Wednesday

Hiking and trail running are easy ways to sprain or break an ankle. Luckily the goats at the top of Sac don't have that problem

​Happy Wednesday everyone! Today I will be continuing with the theme of Wilderness Medicine Wednesday. My goal is to make these posts informational and relevant to things you may commonly encounter on normal outings in nature. I know that a lot of us in the gym love to go hiking and take advantage of all the amazing trail systems around Bozeman. With hiking comes rough trails with lots of roots and rocks. You can probably guess where this is going, today we are going to be talking about ankle injuries!
There are a lot of misconceptions floating around out there about how to properly deal with ankle injuries in a WILDERNESS environment (do not apply the following information to treat your friend at a soccer game in Bozeman) and I want to address some of those. So, let’s go through this process in a somewhat chronological order from the time of injury.
As most of you already know the most likely time for an ankle injury to occur is on the way back to the car. We know we’re getting close, all we can think about is what kind of beer and burger we are going to order at MAP, and BOOM, that one loose rock takes us down. Depending on how far you are from the car when your mind starts to wander this can be a pretty serious emergency. So for the sake of the scenario let’s say you were at the top of Hyalite Peak when the injury happens to one of your friends, you are pretty far from help and at the risk of exposure if you stay up there too long. When dealing with this injury we want to rule out the worse case scenario and work our way down the spectrum.
The first thing you should do is look for obvious deformities in the ankle, is it at a crazy angle or is a bone sticking out? Anything this drastic would indicate a fracture and mean that unfortunately you are carrying your friend down from the top of Hyalite Peak. In another post I’ll write about how to make a litter or carry patients in other ways. Someone with a broken ankle is not going to be putting any weight on the joint.
Barring obvious deformities we still haven’t ruled out broken bones. I’m going to pause here because we now have a decision to make if your friend is wearing shoes that cover their ankle, like hiking boots. It is extremely helpful to remove their shoe to further inspect the injury BUT you run the risk of their ankle swelling and being unable to put the shoe back on. In a WILDERNESS environment this could be even more of an emergency than the actual injury, especially in the cold. My advice here would be to leave their shoe/boot on unless you have easy access to ice or very cold water like a stream or alpine lake. If you can immediately get their ankle on ice or in cold water to prevent swelling go ahead and remove their shoe.  Anyways, the next step is to rule out fractures. There are two tell-tale signs of fractures, one is one definitive, and the other is “pretty” definitive. Point tenderness is the easiest and only exclusive way to diagnose (and I use that world lightly, we’re obviously not doctors) a fracture. There will be a specific spot that hurts them incredibly badly and the rest of the area won’t be so painful. The other way to tell is what we call crepitus, which is a crunchy, clicky feeling they will have if they try to put their ankle through a full range of motion. If your friend exhibits point tenderness and/or crepitus we can probably assume it’s a fracture which still leads us to evacuating them more under our power than theirs.
If we have ruled out a fracture we should now be thinking a sprain/strain. For the purposes of this post and its usefulness I’m not going to go too deep into the difference here. What we need to know is that both of these injuries will show themselves in a few ways: decreased range of motion in the joint, a lot of swelling happening quickly, bruising, and a more dull and diffused pain around the area. The last symptom I mentioned is the big difference between a sprain and a fracture.
The good news with a sprain/strain is that in a wilderness setting this is an injury that we can work through. The best course of action is to have them rest, elevate the ankle for a hour or so, get it on ice or in cold water if you need, and then make your way home. As long as the sprain is not too severe they should be able to walk themselves out of the woods, there will be a lot of pain and complaining but whether they think so or not, they can. Some ways to help them is lending them your shoulder, making some rudimentary crutches from a stick, or creating a splint. A SAM splint is a great tool to buy for your hiking first aid kit. It’s incredibly useful in making splints and other random stuff as well. You can take a look at them here: 
https://www.sammedical.com/products/sam-splint?variant=32444250357869

​Also, see the video below for some tips on how to make an ankle splint. When it comes to splints remember the acronym RAFT (rigid, adjustable, flexible, tight).
As always, I hope that none of you have to use anything that I’m writing about in this post. But, if the next time you’re hiking you or your friend start to imagine that post-hike meal at MAP a little too early and take a tumble, I hope this comes in handy. Cheers everyone and keep having fun outside! 

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