Does your ankle roll over easily? Does it give way even on flat ground? If your ankle has never felt secure since an old sprain, the cause may be chronic ankle instability.
What is chronic ankle instability?
Ankle sprains are among the most common sports injuries, and most heal well with the right care. In some people, though, the ligaments never fully recover and the ankle stays loose. Studies suggest that roughly 20 to 40 percent of people who sprain an ankle go on to develop long-term instability.
Why does my ankle keep giving way?
Usually it starts with a previous sprain that damaged the ligaments on the outside of the ankle, mainly the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL). Besides incomplete ligament healing, the ankle’s sense of position (proprioception) and the surrounding muscles often stop working as well as they should, which keeps the problem going.
It is more common in people who play football, basketball or volleyball, runners and dancers, those with repeated sprains, people with general ligament laxity, and feet with a high arch or an inward-tilted heel. Bone shape can also play a part: Assoc. Prof. Tokgöz’s study on the anatomy of the distal tibiofibular joint and ankle instability was published in Foot & Ankle International.
What are the symptoms?
- Frequent ankle sprains
- A feeling that the ankle gives way or cannot be trusted
- Difficulty on uneven ground and going downstairs
- Fear of rolling the ankle again during sport
- Pain and swelling after long walks
- An occasional catching or locking sensation
For some people pain is minor and the main complaint is simply that the ankle feels unreliable. Left untreated, instability can lead to cartilage damage, osteochondral lesions of the talus, peroneal tendon problems and early arthritis.
How is it diagnosed?
The most important steps are your history and a physical examination of ligament laxity and balance. Weight-bearing X-rays, stress views, MRI and CT may be requested when needed. MRI is helpful for showing the ligaments, but it does not make the diagnosis on its own; symptoms and examination findings are always considered together.
Can it be treated without surgery?
Yes. For many patients non-surgical treatment comes first. A tailored programme usually includes muscle strengthening, balance (proprioception) training, physiotherapy, an ankle brace when needed and a controlled return to sport. Research shows that balance training and a suitable brace reduce repeat sprains.
When is surgery needed, and how is it done?
Surgery is considered when symptoms continue after at least 3 to 6 months of proper rehabilitation, when sprains keep happening, when an athlete is losing performance, or when cartilage or tendon damage accompanies the ligament injury. The decision is never based on MRI alone; lifestyle, activity level and expectations matter too.
The most common operation is an anatomical repair of the stretched ligaments, done fully arthroscopically, arthroscopically assisted or through a small open incision. If the ligament tissue is too poor, or a previous operation has failed, the ligament can be reconstructed with a tendon graft. Cartilage lesions and impingement inside the joint can be treated in the same session.
Assoc. Prof. Tokgöz has published a long-term study of balance and function after all-arthroscopic ATFL repair in Archives of Orthopaedic and Trauma Surgery, and a description of an anchor-free arthroscopic ATFL repair technique in Arthroscopy Techniques.
How long are recovery and return to sport?
A protective boot or splint is used for the first weeks, followed by controlled movement and physiotherapy to rebuild balance and strength. Most people return to daily activities within a few weeks. Return to sport is planned around your progress and usually takes a few months. Rehabilitation matters as much as the operation itself.
Frequently asked questions
Does every sprain tear my ligaments?
No. Injuries range from a mild stretch to a complete tear, and not every sprain means a torn ligament.
My MRI was normal, but my ankle still gives way. Is that possible?
Yes. In chronic instability the physical examination is the key assessment, and a normal MRI does not rule the condition out.
Is wearing an ankle support all the time enough?
A support can protect the ankle during sport, but it does not correct the laxity by itself. It works best combined with balance and strengthening exercises.