Dealing With Ankle Injuries in TEOTWAWKI, by Dr. Bob

The ankle is a frequently injured joint currently with the grid up and will be even more often with the grid down.  Ankles are easily turned, or rolled, with uneven ground, curbs, trees, rocks, etc.  Walking in general and walking in rough terrain are assumed to be more likely in TEOTWAWKI situations.  Almost everyone has had an ankle sprain in their lives, and many people have actually “broken” their ankles.  There will be no local doctor’s office and certainly no X-ray availability without a grid, so how do you take care of an ankle injury and how do you know what is likely to be broken? 

First off, as with most medical issues, we talk prevention.  Watching your step and keeping yourself in good shape is the best way to prevent ankle injuries.  Brushing your teeth while standing on one foot is a great exercise you can do every day to help build ankle strength and help with proprioception (the unconscious ability of your brain to know what your ankle is doing).  Good boots for hiking will help with uneven treks through the wild.  The reason there are not many ankle fractures in skiing…good boot protection of the ankle.  If you don’t have good hiking boots and you are a prepper, you’re doing it wrong!  Get some boots now if you lack them, we recommend multiple pairs for each member of your family.  If nothing else, get them when they are on sale and use them as you wear them out.  Get another pair to replace the pair you take, treating footwear like rotated foodstores.

When there is an injury, treatment will be important.  Treatment done right will be really important, as you want to return productivity and prevent permanent deformity and pain if possible.  There are some simple things to do for all sprains that also work to help heal fractures, commonly known as RICE (Rest, Ice, Compression, and Elevation) therapy. .  Rest, Compression, and Elevation are available to all situations; but ice may be a bit of a problem.  Chemical ice packs should be sitting in your stockpile, and in quantities sufficient for your family or group for a good period of time.  Some folks even use RICEN which adds “N” for your favorite NSAID pain medication to the plan.  NSAIDS include aspirin (Bayer, etc.), ibuprofen (Motrin and Advil), and naproxen (Aleve), along with other prescription medications unlikely to be available post collapse.  Don’t forget that acetaminophen is not the best choice for swelling as it does not work like the others do and aspirin is often tougher on the stomach at higher doses than are the ibuprofen and naproxen.

So next, we ask the age-old question: Is it broken?  Follow the Ottawa Ankle Rules.  If you can’t stand on it and there is horrible pain when you push on the key spots, it is likely broken. If you can stand on it and push on the key spots without horrible pain, it is likely not broken. But we would do an X-ray if there was electricity and an X-ray machine near us.  In TEOTWAWKI, there is no X-ray and so the information is helpful to predict how long to lay up for, but not much else.

So, you turn your ankle badly hunting for the last of the deer, two months post-collapse.  It hurts and you can’t stand on it, so now what? Remember the acronym RICEN, which stands for Rest, Ice, Compression, Elevation and NSAIDs.  Rest means don’t walk on it.  Ice is 6 times on day one, 4 times each day for days 2 and 3.  Compression is that good boot that you weren’t wearing, or an ACE wrap if you have it.  SAM splinting may also help, but you still have to have something to wrap it with.  If nothing else, use T-shirts.  Rope is a bad idea as it will irritate the skin and may cause a secondary problem then.  Elevation is higher than your heart, which is pretty high.  Get it up there and keep it there.  NSAIDs are ibuprofen at 800 mg three times daily or naproxen at 440 mg twice daily if you have them (adult doses).  Using crutches, whether makeshift or available, and if not then a cane may help mobility and help healing.  Pain is the main limit to return to regular activities.  If it hurts, it’s not ready.  That’s a pretty good rule for most sprains and injuries.  Most simple sprains will be back to walking within 4-5 days, severe sprains can take 6-8 weeks, as can fractures.  Obviously, if a bone is broken it needs time to heal or there will be deformity, arthritis and perhaps permanent pain.  Do your best to prevent these injuries, and if they do occur treatment is important for an effective return to functionality.  As always, stay strong.  – Dr. Bob

JWR Adds: Dr. Bob is is one of the few consulting physicians in the U.S. who dispenses antibiotics for disaster preparedness as part of his normal scope of practice. His web site is: