Chronic Ankle Instability
Chronic ankle instability is a condition characterized by a recurring “giving
way” of the outer (lateral) side of the ankle. This condition often develops
after repeated ankle sprains. Usually the “giving way” occurs while walking or
doing other activities, but it can also happen when you’re just standing. Many
athletes, as well as others, suffer from chronic ankle instability.
People with chronic ankle instability often complain of:
A repeated turning of the ankle, especially on uneven surfaces or when
participating in sports
Persistent (chronic) discomfort and swelling
Pain or tenderness
Chronic ankle instability usually develops following an ankle sprain that has
not adequately healed or was not rehabilitated completely. When you sprain your
ankle, the connective tissues (ligaments) are stretched or torn. The ability to
balance is often affected. Proper rehabilitation is needed to strengthen
the muscles around the ankle and “retrain” the tissues
within the ankle that affect balance.
Repeated ankle sprains often cause—and perpetuate—chronic ankle instability.
Having an ankle that gives way increases your chances of spraining your ankle
repeatedly. Each subsequent sprain leads to further weakening (or stretching)
of the ligaments—resulting in greater instability and the likelihood of
developing additional problems in the ankle.
Evaluation and Diagnosis
If your ankle feels wobbly or unstable and gives way repeatedly, or if you’ve
had recurring ankle sprains, see a foot and ankle surgeon to have your
condition evaluated and treated. Chronic ankle instability that is left
untreated leads to continued instability, activity limitations, arthritis, and
In evaluating and diagnosing your condition, the doctor will ask you about any
previous ankle injuries and instability. Then he or she will examine your ankle
to check for tender areas, signs of swelling, and instability of your ankle as
shown in the illustration. X-rays, CT scans, or MRIs may be helpful in further
evaluating the ankle.
Treatment for chronic ankle instability is based on the results of the
examination and tests, as well as on the patient’s level of activity.
Treatment will depend on the final diagnosis and should be personalized to your
individual needs. Both conservative (nonoperative) and surgical treatment
methods may be used. Conservative treatments include:
Anti-inflammatory medications such as aspirin or ibuprofen to reduce swelling
Physical therapy, including tilt-board exercises, directed at strengthening the
muscles, restoring range of motion, and increasing your perception of joint
An ankle brace or other support
An injection of a steroid medication
In the case of a fracture, immobilization to allow the bone to heal
If your condition requires it, or if conservative treatment doesn't bring
relief, your doctor may recommend surgery. Many surgical procedures can be done
on an outpatient basis. Some procedures use arthroscopic techniques; other
require open surgery. Rehabilitation may take 6 to 10 weeks to ensure proper
healing. Surgical treatment options include:
Removing (excising) loose fragments
Cleaning (debriding) the joint or joint surface
Repairing or reconstructing the ligaments or transferring tendons
Almost half of all people who sprain their ankle once will experience
additional ankle sprains and chronic pain.
You can help prevent chronic pain from developing by
following these simple steps:
Follow your doctor's instructions carefully and complete the prescribed
physical rehabilitation program.
Do not return to activity until cleared by your physician.
When you do return to sports, use an ankle brace rather than taping the ankle.
Bracing is more effective than taping in preventing ankle sprains.
If you wear hi-top shoes, be sure to lace them properly and completely.
Non-surgical treatment may include:
Physical therapy. Physical therapy involves various treatments and exercises to
strengthen the ankle, improve balance and range of motion, and retrain your
muscles. As you progress through rehabilitation, you may also receive training
that relates specifically to your activities or sport.
Bracing Some patients wear an ankle brace to gain support for the ankle and
keep the ankle from turning. Bracing also helps prevent additional ankle
Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen,
may be prescribed to reduce pain and inflammation.
In some cases, the doctor will recommend surgery based on the degree of
instability or lack of response to non-surgical approaches. Surgical options
mainly involve repair or reconstruction of the damaged ligament(s). However,
other soft tissue or bone procedures may be necessary depending on the severity
of your condition and whether you have other problems in the foot or ankle. The
length of the recovery period will vary, depending on the procedure or