Ankle injuries are common in the hills, but would you know how to deal with one? Learn to assess the difference between a sprain and a fracture, and what to do about them, with Cory Jones of First Aid Training Co-operative. 

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Twist your ankle at home and it's inconvenient. Do it three hours into a remote ridge walk and it becomes a logistical challenge, and potentially introduces a wider safety concern if the casualty is immobile. Ankle injuries are one of the most common incidents in the hills, from a slight roll on rough terrain to a full fracture after a slip or fall. Knowing how to assess and manage these injuries can make the difference between walking off the hill or calling for rescue.

Spot the signs: sprain or break?

Sprains and breaks can look very similar—both can cause pain, swelling and bruising. While only an X-ray can confirm a fracture, there are signs that help you make a sensible field assessment.

Sprain (ligament injury):

• Pain, especially around the ankle joint
• Swelling and bruising developing over time
• Limited movement, but the casualty may still be able to hobble or weight-bear
• Pain improves slightly with rest and light compression

Break (bone fracture):

• Sudden, severe pain with immediate swelling or deformity
• Inability to bear any weight at all
• Bone or joint may look out of alignment or at an odd angle
• A cracking sound at the time of injury
• Numbness, pins and needles or loss of circulation beyond the injury

When in doubt, treat as a fracture until proven otherwise.

Initial first aid in the field

Whether it's a sprain or a break, your first move is to stop, assess, and stabilise. Use the RICE principle (Rest, Ice, Comfortable Compression, Elevation), adapted for mountain environments:

1. Rest

Get the casualty to sit or lie down in a safe, sheltered spot. Reassure them and reduce unnecessary movement of the ankle.

2. Ice (or the closest thing to it)

In the wild, you probably don't have an ice pack. A stream-cooled water bottle or snow in a dry bag can work in a pinch. Apply for up to 10 minutes to help reduce swelling.

3. Compression

Apply a supportive bandage or tape, wrapping from just below the toes to a few inches above the injury. Don't make it so tight that it cuts off circulation. If there's significant swelling or deformity, do not compress—this could worsen a fracture.

4. Elevation

If practical, raise the injured ankle on a pack, jacket or boulder. Elevation helps reduce swelling and pain—but again, only if this can be done without worsening the injury.

Can they walk off? Making the call

In the mountains, self-rescue is always preferable—if it's safe. Test carefully:

• Can they bear weight without intense pain?
• Can they take a few steps using poles or support?
• Are they steady and alert?

If the answers are yes, they may be able to walk out slowly with assistance, or at least get to a more sheltered location. Strap the ankle for support using tape or a cohesive bandage (vet wrap) and take regular breaks.

If not:

• Call for help (999/112 and ask for the Police who can call out the Mountain Rescue)
• Make the casualty comfortable, warm and sheltered
• Use a group shelter, bivvy bag or foil blanket to reduce exposure
• Monitor for signs of shock or worsening condition

Strapping and support: do it right

If you're confident, taping or bracing the ankle can make walking out possible. The most effective support:

• Wrap from the ball of the foot, around the arch and heel
• Cross over the ankle in a figure-of-eight pattern
• Secure above the ankle joint to limit lateral movement

Carrying cohesive bandages or zinc oxide tape in your first aid kit is smart for exactly this reason.

When to seek medical attention

Even mild sprains should be checked out after a return to base. But urgent care is needed if:

• The ankle is misshapen, visibly deformed or numb
• There is a suspected open fracture (bone showing through skin)
• Pain is extreme or getting worse
• There are signs of poor circulation (cold toes, blue skin, no pulse)
• The casualty is in shock (pale, cold, dizzy or disoriented)

Preventing ankle injuries on the hill

Train hard, carry well, and walk safe.

• Use supportive footwear with good tread
• Watch for fatigue—most sprains happen at the end of a long day
• Use trekking poles to reduce ankle strain, especially downhill
• Practice walking on rough terrain to build strength and coordination
• Carry a well-stocked first aid kit with bandages, tape and pain relief

Final word: be ready, be realistic

An ankle injury might sound minor, but in a mountain environment, it can quickly turn into a complex problem. A good first aid response starts with clear thinking, calm management, and knowing when to move and when to stay put.

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About the Author

Cory Jones has been an International Mountain Leader for two decades, and is a wilderness first aid trainer. He is a founder member of First Aid Training Co-operative, who offer comprehensive first aid courses tailored to outdoor environments, with training built around real-life scenarios that apply to mountain users, from climbers to runners and walkers.

When the unexpected happens, knowing what to do can be the difference between discomfort and a serious emergency. Whether you're leading a group or heading out solo, first aid training tailored for outdoor environments gives you the confidence to respond effectively.