Ankle Injuries, Care and Recovery


Experience From - Karl King , Maarten van Gelder , Janice O'Grady #1 , Dave Cooper , Matt Mahoney , Hank Garretson , Janice O'Grady #2 , Kevin O'Neall , Karl King #2 , Mike Bate , Unknown , Susan Weisser , Rich Lacey , Martha Holden #1, Dick Vincent , Tim Erickson , Eric Ivey , Derick , Jay Hodde , Michael Scandrett , Claude Sinclair , Martha Holden #2 ,

Karl King #1

Phil Sheridan asked about ankle injury recovery.

Mid August my training partner and I were running on the Glacial Trail course which has a good share of rocks in spots. She turned her ankle like Phil but only once. That was about 5 minutes after we started. She was tough enough to complete the 20 miler we had planned, but the next day the outside of the ankle was very swollen. She iced a couple times ( should have done more ). I suggested the following nutritional supplements:

  1. 1 gram Glycine
  2. 1 gram Lysine
  3. 1 Aleve
  4. 1/2 gram buffered vitamin C

She took that with breakfast and at bedtime. Her ankle remained puffy for a couple weeks,but the strength and mechanical integrity returned very rapidly; she skipped a couple short training runs but was able to get in the planned long runs.

The supplements listed above provide the major building blocks for connective tissue. The Aleve is an anti-inflammatory.

This is presented as an example of one person's experience and is not intended as a prescription for Phil or anyone else.

Maarten van Gelder

Chris Stathman wrote:

"Does anyone have any suggestions on how to keep from spraining an ankle? This seems to be becoming a common problem for me. Seeing that most of my runs are on uneven trail and I hate having to run 30-40 miles plus with a torqued ankle, any suggestions. I've thought about taping my ankles for the upcoming Sunmart but worry about blisters, foot cramps, from the tape. An ankle brace has also been considered. Anyone with a similar problem that might offer any advice?

After spraining my right ankle a couple of times, I have taken to wearing a ankle brace for long trail runs, including twice in the Mountain Masochist 50 mile trail race. The brace (Swede-O ankle armor, from a local CMT store) works fine in preventing further sprains. In the first long race I ran wearing the brace, I got some rubbing wounds from the brace. Preventive taping with some sport tape on the few areas subject to rubbing has helped me getting through trail races with intact skin, that is under the brace at least ;-) I haven't ventured beyond the 50-miles. If someone has worn an ankle brace in 100 milers, I would be very interested in her/his experience.

Taping an ankle is an option I tried briefly but found too cumbersome and not always that effective. The tape wouldn't always stick for the duration of the run.

Janice O'Grady #1

Gosh, it seems everyone is repeating all my medical problems. I just relied to Chuck Jones' question about his neuroma. Sprained ankles were also a big problem for me. My left one was particularly bad, and I ran with a lace-up brace for years. Then I started repeatedly spraining the right one. I refused to wear two braces, so learned to tape. I started out with a full athletic tape job, but got terrible braces. So I experimented with less and less tape and finally arrived a system of "stirrups" anchored at the ankle bone. I got blisters at first but then got toughened up at the rub points so I don't even know it's there anymore. It gives just enough lateral stability so my ankles don't roll over quickly and I can catch myself. I haven't had another sprain in the three years I've been taping. Let me know if you want more specifics on how I do the tape job.

Dave Cooper

I have worn lightweight ankle supports(pull-on type by ace or whoever) plus I have also worn ace bandages and have had no additional problems with blisters, etc due to the extra material. I do however, wear the wrap or pull-on over top of my socks and be careful not to wrap too tight - you must experiment. Hope it works for you.

Matt Mahoney

"Does anyone have any suggestions on how to keep from spraining an ankle?"

Work on strengthening your calves. Those are the muscles that you use to shift the weight from your heels to your toes when you start to twist your ankle. Do sitting and standing calf raises with weights, run backwards, run barefoot, and run up and down stairs (real stairs, not a machine. It's going down that really works your calves).

Hank Garretson

I am no expert, but I believe all the talk about braces and taping is barking up the wrong tree.

I quote from September 95 MastersSports, "Workout: The Power of Proprioception."

"The body has an ingenious network of sensors that are in charge of "proprioception," one of those lofty medical terms that refer to a simple process. In this case it's the process of telling your brain where all the parts of you body are in space."

[Proprioception] is usually ignored after an injury ..., boosting the risk that your recovery will be short-circuited before it's ever finished. A sprained ankle is the typical story. The torn ligaments in your lower foot get all the attention--the ice, the stretching, the strengthening. As far as you're concerned the worst is over when you start feeling good enough to let you back onto the roads or the court. What you don't realize is there's more to the problem. Your balance needs repair too. Those little proprioceptive fibers got torn along with the ligaments and, left to fend for themselves, they are going to come back a lot slower. ..."

So, you need to rehab both strength AND balance/proprioception. If you don't you are setting yourself up for another sprain. Pretty soon you will label yourself as having "weak ankles," when in you actually have weak proprioception.

The one-page article gives four "Balance Builder" exercises. If you want a copy, send me a stamped, self-addressed envelope.

Janice O'Grady #2

Here's what works for me. I've been successful with it through Leadville, Wasatch and Angeles Crest. Put one strip around hour ankle just above the ankle bone as an anchor. Flex your foot as you apply the stirrups. Start with one stirrup pulled straight under your foot at about the ankle bone--you'll be able to figure out where it feels right. Pull it fairly tight, sticking the ends to the anchor strip. Angle the next stirrup so that the outside end is just behind your ankle bone and the inside end is forward. Then angle the next one the opposite way (I wish I could draw you a picture!). Then put one more straight one over them. Then wrap another anchor around your ankle over the ends of the stirrups--I wrap it around twice to make it good and secure. By the way, I've found that Mueller tape works much better than Johnson's--Johnson's isn't sticky enough. And I don't use any spray or under tape, just stick it to the skin. Let me know if this doesn't make sense to you and I'll try to explain better.

Kevin O'Neall

Years of hill climbing has given me very strong calves but hasn't strengthened my ankles at all. I run 80% on roads. When I get out on a trail, the next day my ankles really ache. So I would suggest trail running will strengthen ankles.

An exercise I found is to forcefully rotate your foot 50 repetitions each direction, 4 or 5 sets. It's harder than you'd think. This will strengthen the collateral ligaments which aren't worked very much when running roads. Another exercise I've thought might help is to put on ice skates and, while standing, bend the ankles to the right, then left. I've seen footballers in rehab using a machine which does mimics this motion. I don't own ice skates to I've never tried that one.

Karl King #2

I don't have a short term solution, but do have a suggestion for longer term. That is, strengthen the ankle so it is less prone to sprain. Years ago I began to frequently sprain my right ankle. A book by John Jesse, "Hidden Causes of Injury, Prevention and Correction for Running Athletes , The Athletic Press 1977, Library of Congress catalog number 77-12214, describes two devices for strengthening the ankle. They are home-made. The one I use, has a square base 14 inches by 14 inches (from say one inch wood) with just two sides rising from opposite sides of the base - these two sides rising 12 inches and connected by a 2 x 4 for rigidity. The two sides slope upwards so their top horizontal edge is say 6 inches long , while 14 inches at the base.. Thus just 4 pieces of wood - one base, two sides, and a connector between the sides.

Hollow a half circle in the top edge of the sides to hold a dowel or broomstick in place. Take a 4 x 4 as long as your foot, and embed dowels (pieces of broomsticks) in each end, long enough to extend a couple of inches beyond the half circles hollowed in the sides. (thus the 4 x 4 is suspended between the two sides with the dowels placed in the half circles) Bore a hole through the 4 x 4 perpendicular to the length of the 4x4.

Insert through this hole a new portion of a broomstick. On one end of the broomstick, hang a 10 pound weight (maybe 2 pounds or 5 pounds to begin).

Keep it in place with a collar from a weight lifting bar, or by just boring a hole thru the broomstick, and inserting a peg to block the weight from slipping off.

On the opposite end of the piece of broomstick, bore several holes.

Use a large nail as a peg, and insert in one of these holes to keep the piece of broomstick from pulling through the 4 x 4 by the weight of the weight.

Fasten straps to the 4 x 4. Use the straps to attach your foot to the 4 x 4. Lift the weight 25 times (maybe 10 to start) by rotating the foot at the ankle joint, working the muscles and ligaments on the side of the leg and foot.. It's awkward, but persist. Pull the nail out of the broomstick, slip the stick out of the 4x4 and reverse direction. Thus you can equally strengthen, both sides of the foot.

This has eliminated ankle sprains for me. A friend terribly sprained her ankle a few years ago, and I had a carpenter duplicate my home made model. She has gone from frequent sprains to none. This probably won't work for all, but based on my experience it is worth a try. I apologize for the wordy directions and no pictures.

If you ask me, I'll be glad to Xerox the drawings from the book and send you copies, if you send me your address. I will respond after December 20 due to commitments before then.

Mike Bate

I haven't had chance to read a lot of the posts lately, so I am not sure whether this suggestion has been raised before.

But regards sprained ankles, I have for long had problems with my right ankle due to a football injury when young leaving it weak, and had quite a few problems with sprains when racing on rough ground...

..but I have eliminated the problem over the last year or so by acting on a tip from a sports physiologist at Club La Santa Lanzarote, who suggested an ankle strengthening exercise which is simply balancing one foot held flat on the ground with the other leg bent back at the knee as if in the mid support phase of normal running action. When you have got your balance doing this, then close your eyes and do the same thing, holding the balance for up to 4-5 minutes. Without eye feedback inevitably you lose balance a fraction and then recover repeatedly , which gradually strengthens the ankles, doing this as a part of stretching maybe every couple of days.


Tom Hughes wrote:

" Here is my nonmedical advice and experience about ankle injuries. I sprained my ankle midway through the Ice Age 50 mile run. Like yourself I was put in an air cast. I found that once out of the cast easy exercise like walking and biking accelerated the healing a great deal. I was very careful to stretch the ankle but not strain it. If I felt strain I stayed off of it. From there I moved to hiking rough terrain and easy running of flat, smooth surfaces. Two months after the initial injury I was able to run a 50K race without concerns for the ankle."

I had basically the same experience with a severe ankle sprain. Incidentally, I came across a book called "Bonnie Pruden's Guide to Pain-Free Living." Very interesting. Pruden is an exercise pioneer who discovered that injuries healed far more rapidly when given the most active convalescence possible, including range-of-motion exercises that she describes in detail. It really does work. I ran an 8K shortly after emoving the cast, started cautiously and then the last miles at 7:00-7:30 pace. I believe it significantly accelerated my recovery.

Susan Weisser

I sprained my ankle skiing this past April, and received a lot of good advice from the list, particularly when I realized I'd have to cancel some events I'd been planning for over 9 months.

Cross training was essential, since I had begun what I perceived to be a precipitous loss of lean muscle mass in my quads. I started swimming and got an aquajogger, which allowed me to run without the impact. Cycling did not hurt my ankle, so that was also good for leg muscles, and aerobic conditioning, since I live in a very hilly area.

The most beneficial aspect of getting me back on the trail quickly , however, was Physical Therapy. I went to a Physical Therapist who also happened to be an athlete. Her approach with me was... what do we need to do to get you back on the road? She used very aggressive (read..painful) massage, ultrasound, electro-stimulus and strengthening exercises with me. What we accomplished in a month was equal strength in both ankles, and retrained proprioception in the affected ankle. Proprioception being the signals your ankle sends to your brain that you are on uneven terrain, and make adjustments accordingly. I told my Physical Therapist that "weak ankles" was not an option for me.

Lots of people told me I'd be taking the entire summer off from ultra running, but the good news was I took a relatively poorly trained body to KKNSTR in Mid-July and finished! Okay, so it was slow, but I started the race thinking I'd drop @ Cleveland Dam, the half way point, but I ran the race in such a way that not only did I finish, but was able to run all out in the last 2-3 miles, and finish very strong. I did a quasi-professional tape job on my ankle before the race, a technique my Physical Therapist had shown me, and the ankle held up very well on some "knarly" terrain.

The time off from running was not totally unproductive. I learned a lot about X-training, and pushing myself in other ways physically besides running.

Rich Lacey

Having suffered multiple sprains of my chronically unstable left ankle over many years from training on smooth surfaces (I'd sprain it on a crack in the sidewalk, much less a root, rock, or hole), I learned from a podiatrist how to retrain my ankle to withstand the treacherous terrains of trails, and to prevent future sprains. As a result, I scrapped conventional remedies (tape, braces, etc.) and have rarely experienced even minor sprains, and have had no major mishaps. The technique: proprioceptive rehab. It's simple, you can do it anywhere, and it works. You retrain your nerve endings "proprioceptively" that is, to be unconsciously aware of stimuli arising within your body, including its spatial orientation to prevent and counteract potential sprains.

To train the correct proprioceptive receptors, which link to the inner ear, stand on the vulnerable foot, preferably in a doorway, close your eyes, and try to stay balanced for a full minute. At first it's frustrating: you'll have to steady yourself by using the doorway, and you'll probably have to open your eyes initially, but eventually you can stay balanced as your body and brain "re-wire" the nerve circuits. When your ankle is okay again, you'll find that your body automatically reacts to prevent the sprain when the nerve endings detect a twist or turn.

Martha Holden #1

I twisted my ankle slightly last night about 6 minutes into a run -- not horribly, just enough that to say a few bad words and know that I shouldn't finish the run. I went home and iced it.

It's not swollen--just a little stiff/sore right behind the ankle bone. I'm scheduled for a (slow) 2 1/2 hour long run tomorrow which I really want to do, having just gotten back on a regular running schedule.

Our group bestows the name "bonehead" on a person when they run when they shouldn't. Is running tomorrow going to qualify me as a bonehead, or will my ankle be okay? I'm guessing that listers have a bit of experience with twisted ankles from the trail running, so thanks in advance for any advice you can share.

Dick Vincent

My feeling about twisted ankles is that the best thing you can do is to get out on it as soon as possible. The "Worst" thing you can do is to twist it again. If you are planning to get out and run on it today, wrap it good with tape or a brace so that it won't twist easily (it is very weak now and susceptible to another accident). Pick a surface that is as smooth as possible (and with few hills) and plan a slow run. Use walking breaks when it gets achy. I often find that after a half hour or so of very slow slogging along, that the soreness works it's way out of it and off you go... I suspect that it will be the sorest and stiffest in the morning when you rise and that you may have to walk around on it (limp around) for a while before you go run. Take only what it gives you and don't have expectations of accomplishing much as far as expected workouts for a few days. If by accident you turn it again, you could be in for big trouble. Make sure to ice afterwards.

If you are interested, drop me a line and I can describe a taping method that works very well. Good luck.

Tim Erickson

As someone who has twisted my ankles many times, I say if it is not swollen, discolored, or hot to the touch, it is ok to run on. I have had twisted ankles that were just stiff the next day and others that swelled up and turned purple. The prior I could run on. You did the right thing yesterday by immediately icing it.

Please keep in mind, however, that I am not a doctor. Just somebody with a little bit of twisted ankle experience. I know what works for me.

Eric Ivey

I have a very bad right ankle, due to having it shattered years ago playing soccer, so it is very prone to twists and sprains these days. I am by no means a doctor but I can tell you what works for me. I always carry an ACE ankle brace (the kind you put on like a sock, sorta) with me and if I happen to twist or roll it and it feels like a bad one I will put the brace on and take it easy. I always make sure to ice it when I get home, and a have one of those foot massagers that you put hot water in - I use that for awhile to kinda soothe the achiness. Next day, no problems and it's back to normal. Now, I don't know how long this method will work before my ankle just decides to die completely, but it seems to be working.


Most likely I wouldn't want to be one of my own patients because I tend to play down any injuries and try as soon as possible to get back to running after and ankle sprian/strain. I think after years of having inversion ankle sprains and finally another accident that required reconstructive surgery for some ligaments in my ankle, I now have more peroneal strains and less ligament sprains because of adaptive lengthening of those structures. I would still ice after the run. go ahead and run though and let pain be your guide. Don't try technical single track yet. do start to work on single leg balance exercises as soon as you can tolerate them. Currently there are 2 schools of thought for taping an ankle. one is to tape it into dorsiflexion and eversion so that you limit the ankle from going into the direction it was sprained. The other is one i just learned...where you have to have someone reposition the lateral malleolus of the fibula posterior and superior. That should allow the ankle to function normally while taking up the slack caused by the adaptive lenghtening that chronic ankle sprainers may have. The nice thing about the first one is that you can do it yourself though.

Jay Hodde

Dick wrote:

My feeling about twisted ankles is that the best thing you can do is to get out on it as soon as possible. The "Worst" thing you can do is to twist it again.
I must respectfully disagree.

I won't offer specific advice because I don't know the specifics of the injury, but running with a severe sprain can cause more problems than just twisting it again.

Among them:

  1. Changing your gait due to guarding the injury. This will happen, and the resultant changes can lead to overuse injuries in other areas of the body. Possible scenarios are too numerous to mention quickly.

  2. Increasing the severity of the sprain. You just prolong recovery.

  3. Rarely, subluxation of the joint, but possible if the injury is severe. Usually, there will be some minor "slipping" of bone surfaces that can cuase problems if the joint mechanics are thrown off by the sprain. I'd worry about bruising bone surfaces and possible complications later in life -- even increasing the risks of arthritis.

Just some additional things to think about.

Michael Scandrett

Having survived a couple of bad ankle sprains, my advice would be to stay off it for two or three days and use ice and elevation initially, then get back on it and use an "active recovery" strategy that involves first walking, then running as much as tolerated. With a mild sprain, you should be able to be back on your regular training schedule within one to two weeks. Use an ankle brace or "air cast" to keep from reinjuring your ankle at first. I believe staying active (within reason) will result in faster recovery, but I'm not sure you should try running for 2+ hours so soon after the injury. Others on the list might have advice on this issue. You might also check out John Vonhoff's book "Fixing Your Feet."

Claude Sinclair

Tape it using the high dye strap. That will stabilize the ankle. But wait until the swelling goes down. If it still hurts after it is tape then don't run. Better yet, see a running podiatrist or one who treats runnrs. I have flat feet and during my first 10 years of running I turned many ankles. Well actually one ankle many times.

Martha Holden #2

In regards to my previous question... I was able to run that weekend (3 hours on roads) and it seems to be healing well. Below is a summary of the suggestions and advice received; I hope it may be helpful to someone else as well:

  1. More people said run than don't run (probably based on the fact that it was a slight sprain, not a severe one). Someone summed it up quite nicely:

    "Let pain be your guide. If the ankle is stiff/sore when you first start keep going and see if it loosens up. If it doesn't get worse or feels better you are probably Ok. If the pain increases you should call it a day, go home and ice. It is probably best to stay off of trails or roads with lots of pot holes. Even after a slight sprain your ankle is weaker and you are more likely to reinjure it -- the next time will be worse"
  2. RICE (Rest/Ice/Compression/Elevation)--some combination of these.

  3. Use a brace or tape it until it feels strong again.

  4. Take some ibuprofen or other anti-inflammatory.

  5. Don't run if you have to change your gait or stride to compensate for the ankle.

  6. Try Arnica ointment (homeopathic remedy).

  7. Cross-train for 2 days - 2 weeks.

  8. Try a hot water foot massager after you ice it.

  9. Sleep with a sock on to keep it warm ("Tissues heal with nutrient input, and that comes almost entirely from blood flow.")

  10. "It's good to ice, and the best time to ice is just before you go to bed. Then put the sock on to keep your foot warm. An hour or two after falling asleep you get a pulse of growth hormone that produces most of the healing. If you can tolerate dairy products, it would be good to have some 30-60 minutes before you go to bed. If you are really, really serious about the healing, you'll also take a packet of Knox gelatin."

  11. Strengthen your ankle by balancing on one foot.