by Richard B. Jones, M.D.

Is there any difference in ankle support in a low-rise hiking shoe versus a mid-high shoe or high-cut boot? When it’s hot I prefer a low-cut boot but wonder if I’m making a mistake.
–Shaun B., Black Mountain

The higher the ‘upper,’ the better the support. However, in the long run high-cut boots will produce weaker ankles because the ligaments and muscles become dependent on the support. Those who wear less substantial ‘uppers,’ such as runners, force their muscles and ligaments to work more actively, which provides an explanation as to why we tend to see more ankle sprains in basketball players than runners. Rotating your boots from low to high ‘uppers’ based on terrain and heat might be a good strategy, as it will allow you to alternate support and strengthening for your ankles.

What type of exercises should I be doing to strengthen my ankles, legs, and torso for a multi-day backpacking trip?
–Rich M., Morganton

Practice hiking with the weight you are planning to carry. The ankle is just like any other joint in the body, in that an overload of the joint over a period of days can produce pain and may even precipitate a higher incidence of injury. In the wilderness setting this is a more serious concern because the backpacker is more top-heavy with a pack, and an accident could result in a more substantial injury. You can strengthen your body in many ways without even stepping into the gym. For your ankles, practice walking on your heels for 1-3 minutes at a time and feel the burn! Balance exercises are also quite beneficial; try ‘the sobriety test’ as a good example. Stand on one leg, with the opposed leg lifted up, arms outstretched, and head tilted back. This will also strengthen the ankle through the use of proprioreception, and is good practice in case you are ever called upon to do this in a “field test.” Lunges and wall stretching are a plus, and add some free weights to tone the torso and build ankle strength.

Last year I injured my ankle on a multi-day hike. What first aid should I have performed, and what supplies should I carry just in case?
- Lisa B., Spartanburg

Consider adding an ace bandage to your supplies, as well as an over-the-counter non-steroidal anti-inflammatory (NSAID). For an ankle injury, try soaking the joint in a cold stream as often as possible. Then take a double dose of the NSAID for three days and a regular dose after that. Wrap the affected ankle with the ace bandage and sleep with it elevated. This will hopefully get you through a planned outdoor adventure. A more serious injury may require more immediate care and disruption of your trip. In either case, follow-up care is a good idea, especially if pain persists.

Dr. Jones is an orthopedist with fellowship training in Sports Medicine at the Cleveland Clinic practicing in the Asheville area.