An ankle that repeatedly gives way after a sprain may have chronic ankle instability. This can involve stretched or damaged ligaments, reduced balance and position sense, weakness, restricted movement, or another injury that was missed during the original episode. A structured rehabilitation program is usually the first treatment; surgery is generally reserved for selected people with persistent instability despite appropriate non-surgical care.
Seek prompt assessment after a new injury if you cannot put weight on the foot, the ankle looks deformed, pain is severe, or swelling and function are getting worse. Recurrent giving way also deserves assessment because repeated sprains can affect confidence, activity and the joint over time.
This article provides general information and does not replace an individual assessment by a qualified health professional.
What is chronic ankle instability?
Chronic ankle instability describes a pattern of repeated ankle giving way, recurrent sprains or an ongoing feeling that the ankle is unreliable after a previous ligament injury. Some people notice it during sport or on uneven ground. Others feel the ankle buckle during ordinary walking.
The problem is not always simply a loose ligament. Stability depends on several systems working together:
- the ankle ligaments and joint surfaces
- strength and timing of the muscles around the ankle and leg
- proprioception, which is the body's sense of joint position
- balance and reaction to an unexpected change in surface
- ankle movement, especially the ability to bring the shin forward over the foot
- movement control at the knee and hip
This is why treatment that only rests the ankle or relies permanently on a brace may not restore confident function.
Why does an ankle keep giving way after a sprain?
The ligament did not regain sufficient stability
A lateral ankle sprain can stretch or tear the ligaments on the outside of the ankle. Some heal with residual laxity, particularly after a severe injury or repeated sprains.
Balance and position sense remain impaired
Ligament injury can disrupt the sensory feedback that helps the body respond when the foot starts to roll. The ankle may feel unpredictable even when a clinician does not find major mechanical looseness.
Strength and movement were not fully restored
Pain may settle before calf strength, ankle range, hopping, landing and change-of-direction ability are ready for full activity. Returning to sport based only on time can leave important deficits untreated.
Another condition is contributing
Persistent symptoms can also come from an osteochondral injury, tendon problem, impingement, an unrecognised fracture, arthritis, nerve symptoms or the shape and alignment of the foot. A proper assessment checks for these alternatives rather than labelling every recurrent episode as a simple sprain.
What symptoms suggest chronic ankle instability?
- repeated rolling or giving way
- more than one sprain of the same ankle
- lack of trust in the ankle during sport, stairs or uneven ground
- persistent swelling, tenderness or aching
- reduced range of movement
- difficulty balancing on the affected leg
- avoiding activity because of fear of another sprain
The phrase chronic does not mean the problem cannot improve. It indicates that symptoms have continued or recurred beyond the expected recovery from the initial injury and need a more complete assessment.
Who should you see?
A GP, physiotherapist or sports physician can be an appropriate first contact. They can assess the injury history, walking, range, strength, balance and whether imaging or referral is needed. A podiatrist may also help when footwear, foot mechanics or orthoses are relevant.
An orthopaedic foot and ankle surgeon becomes more relevant when:
- the ankle continues to give way after a well-performed rehabilitation program
- recurrent sprains prevent work, sport or normal daily activity
- examination suggests marked mechanical instability
- there may be associated cartilage, tendon, impingement or bony injury
- imaging identifies a condition that may need an operation
- the diagnosis remains uncertain despite appropriate care
You can compare foot and ankle surgeons in Perth when a surgical opinion has been recommended.
How is chronic ankle instability assessed?
A clinician will usually ask about the first sprain, the number of subsequent episodes, treatment completed, current activity and exactly when the ankle feels unstable. Examination may assess:
- swelling, tenderness and foot alignment
- ankle and calf range of movement
- ligament stability tests
- strength of the ankle and lower leg
- single-leg balance
- walking, squatting, hopping, landing and change of direction when safe
- movement control through the foot, ankle, knee and hip
The 2021 lateral ankle sprain clinical practice guideline recommends using validated patient questionnaires and functional tests rather than relying on one manoeuvre. This helps distinguish the person's perceived instability from mechanical ligament laxity and measures whether treatment is changing function.
Do you need an X-ray or MRI?
Not everyone needs imaging. After a new sprain, a clinician may use established decision rules and examination findings to decide whether an X-ray is needed to look for fracture. Persistent pain, locking, catching, repeated swelling or failure to improve may justify further imaging for cartilage, tendon, ligament or bone problems.
An MRI can show soft-tissue structures, but it does not measure confidence, balance or dynamic control. The result should be interpreted alongside the history and examination.
What is the first-line treatment?
For chronic ankle instability, rehabilitation should address the deficits found in the assessment. The JOSPT guideline recommends proprioceptive and neuromuscular exercise to improve dynamic balance and the person's sense of stability. A program may include:
- progressive calf and ankle strengthening
- single-leg balance with increasing challenge
- ankle mobility work where movement is restricted
- hopping, landing and direction-change drills for active people
- sport- or job-specific retraining
- graded return to the activities that trigger instability
A brace or taping can reduce reinjury risk in some activities, especially during return to sport, but the guideline advises against using external support as the only treatment for chronic instability. Exercise restores capacities that a brace cannot replace.
When is ankle ligament surgery considered?
Surgery may be discussed when disabling instability persists despite appropriate rehabilitation and there is a structural problem that an operation can reasonably address. The aim may be to repair or reconstruct damaged lateral ligaments. Associated cartilage, tendon or impingement problems may also need treatment.
The decision is individual. A surgeon should review:
- the number and severity of giving-way episodes
- whether a complete rehabilitation program was followed
- clinical and imaging evidence of mechanical instability
- other conditions inside or around the ankle
- work, sport and daily-life requirements
- health factors that influence surgery and recovery
Ask what problem the operation is intended to correct, what non-surgical options remain, what rehabilitation will involve, and whether the expected improvement matches your goals.
How can another ankle sprain be reduced?
- complete rehabilitation beyond the point when pain first settles
- restore balance, strength and task-specific control
- build training load gradually
- use appropriate footwear for the surface and activity
- consider taping or bracing for high-risk sport after professional advice
- do not return to competition solely because a fixed number of weeks has passed
Return-to-sport decisions should consider symptoms, ankle impairments, confidence, balance, hopping and sport-specific performance. Someone who can walk without pain may still be unprepared for landing or rapid direction changes.
Do you need a referral to a foot and ankle surgeon?
A valid referral is generally required to claim the relevant Medicare specialist benefit. A GP can summarise the injury history, instability episodes, treatment completed and relevant imaging. Read the Australian orthopaedic referral guide before arranging an appointment.
For an injury caused by sport, a sports orthopaedic surgeon in Perth may also treat ankle ligament injuries. The most relevant choice is a clinician whose documented practice includes the ankle and the suspected condition.
Frequently asked questions
Can chronic ankle instability improve without surgery?
Yes. Many people improve with an individual program addressing strength, balance, mobility, confidence and activity-specific control. Surgery is usually considered only when meaningful instability persists despite appropriate rehabilitation.
Is an ankle brace enough?
A brace may provide useful support and reduce reinjury risk in selected activities, but it should not replace rehabilitation. Persistent instability needs assessment of strength, balance, movement and possible structural injury.
Why does my ankle give way without pain?
Giving way can reflect impaired balance or position sense as well as ligament looseness. Lack of pain does not prove that strength and control have recovered.
When should a recurrent ankle sprain be assessed?
Arrange assessment when the ankle repeatedly gives way, swelling or pain persists, function is not improving, or you cannot return confidently to work or sport. Seek prompt care after a new injury if you cannot bear weight or the ankle is deformed.