Chronic Ankle Instability

Ligaments are bands of tough fibrous tissue that connect bone to bone and stabilise your joints. When you sprain your ankle, your ligaments become damaged or torn. If you repeatedly sprain your ankle, or if your ligaments do not fully heal after an ankle sprain, you may develop chronic ankle instability.

You are more likely to develop chronic ankle instability if you:

• Frequently take part in sports that involve running, jumping, or rapid changes of direction such as basketball, tennis, and football
• Have previously sprained or injured your ankle

Symptoms of ankle instability include:

• Pain, swelling, stiffness, or tenderness in the ankle joint
• Your ankle 'gives way', or rolls inwards
• Your ankle may feel unstable or wobbly, particularly when walking or running on uneven surfaces or participating in sports

Your consultant will ask you about your symptoms and whether you have injured your ankle before.

They will examine your ankle to look for outward signs such as bruising, swelling, or deformity. They may apply firm pressure to your ankle to see if you have any pain or tenderness and check your muscle strength and range of motion (how well you can move your ankle joint).

They may ask you to perform a range of movements such as walking, standing on tiptoe, and standing on one leg to check your sense of balance and see how your ankle works when you are moving.

Will they need tests or scans?

Having discussed your symptoms and examined your ankle, your consultant may order some scans to confirm your diagnosis. These may include an X-ray, ultrasound, MRI, or CT scan.

Why is this first consultation so important?

Your first consultation at Circle Health Group is important because it's where we first get to meet you, discuss your symptoms, and learn about your expectations for treatment.

At your first consultation, your consultant will provide a diagnosis based on your symptoms, physical examination, and the results of any tests or scans. They will then discuss the best treatment plan for you based on your diagnosis.

At Circle Health group, it's very important to us that you are as comfortable and well-informed as possible throughout your treatment. Please feel free to ask any questions or discuss any concerns you may have with your consultant at any time.

There are several different treatments for chronic ankle instability. Your consultant will decide which one is best for you based on your examination and tests, how severe your ankle instability is, and how much it affects your ability to move and carry out daily activities.

Non-surgical treatments

• Medication - non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help to relieve pain and reduce swelling. In some cases, steroid injections may be given to reduce swelling and encourage healing
• Physiotherapy - aims to increase muscle strength and re-train damaged tissues to respond to the movement of the ankle
• Orthotics - if your foot shape is contributing to your ankle instability, custom-made orthotic shoe insoles may be recommended to reduce stress on the ankle joint
• Bracing - wearing an ankle brace can provide support and stability to your ankle joint as well as prevent further ankle sprains. Keeping your joint immobilised in a brace and possibly using crutches may be recommended for a few weeks to allow your ankle to heal

Surgical treatments

If your ankle instability is severe or doesn't improve with non-surgical treatments, your consultant may recommend surgery.

There are three main surgeries for ankle instability:

• Arthroscopy - this technique examines the ankle joint using a tiny camera called an arthroscope. It may be used to make a diagnosis or along with surgical instruments to repair damaged ligaments
• Brostrum's procedure - this is the most common surgical intervention for chronic ankle instability. During this procedure, damaged ligaments are repaired, tightened, and re-attached to the bone
• Tenodesis procedure - involves creating new ligaments from strips of your hamstring (tendons at the backs of your thighs). This type of surgery is usually only recommended when other options haven't worked

Risks and complications of surgery

Ankle stabilisation surgery is a relatively low-risk procedure, but as with all types of surgery, complications may occur. Your consultant will discuss all possible risks and complications with you before your surgery so that you can make an informed decision.

Possible complications of ankle stabilisation surgery include:

• Bleeding
• Infection
• Blood clots
• Adverse reactions to the anaesthetic
• Nerve damage
• Stiffness in your ankle joint

What causes chronic ankle instability?

Chronic ankle instability is usually caused by having a sprained ankle, or multiple sprained ankles that haven't healed properly.

Can chronic ankle instability be cured?

Yes. Effective non-surgical and surgical treatments are available to correct chronic ankle instability. For the best chance of recovery, you should start treatment as early as possible after developing chronic ankle instability.

What does ankle instability feel like?

Ankle instability normally feels like the ankle is unstable, wobbly, and about to 'give way' and roll inwards. There may also be pain, tenderness, and stiffness in the ankle joint.

Is chronic ankle instability a disability?

Whether or not chronic ankle instability is a disability depends on how severe your ankle instability is, and to what extent it affects your ability to work and carry out day-to-day tasks. Untreated ankle instability can lead to problems like recurrent ankle sprains and arthritis that may cause long-term disability. Chronic ankle instability is assessed on a case-by-case basis.

Can I wear high heels after ankle instability surgery?

Wearing high heels puts a strain on your ankles and can damage your feet, legs, knees, and back. It may be possible to wear low heels for short periods when you have fully recovered from your ankle surgery. Talk to your consultant about if and when you can wear high heels after your ankle surgery.

Is chronic ankle instability permanent?

If untreated chronic ankle instability is likely to be permanent and may lead to complications such as recurrent ankle sprains and arthritis. If you think you have chronic ankle instability, make an appointment with a doctor, and start treatment as soon as possible to prevent further problems.

Will massage help ankle instability?

If you have sprained your ankle, massage can help reduce pain and swelling and increase flexibility which may decrease the risk of developing chronic ankle instability. If you already have ankle instability, massage alone is unlikely to be effective and may make your condition worse. If you think you may have chronic ankle instability, make an appointment with a specialist to get a diagnosis and discuss treatment options.

• Flexible appointment times and locations that are convenient for you
• The freedom to choose which hospital and consultant best suit your needs
• Personalised, consultant-led treatment plans tailored to your individual needs
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private en-suite rooms as standard
• A range of delicious healthy meals
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to see a consultant or learn more about chronic ankle instability treatment, book your appointment today or call a member of our team directly on 0141 300 5009

Content reviewed by Circle in-house team in December 2022. Next review due December 2025.

1. Chronic ankle instability: Current perspectives, PubMed
2. An Updated Model of Chronic Ankle Instability, PubMed
3. Patient Information: ankle instability, West Suffolk NHS Foundation Trust
4. Chronic ankle instability, American College of Foot and Ankle Surgeons