Chronic Ankle Instability

Name: Chronic Ankle Instability
Creator: Prof Paul Lee

Chronic ankle instability develops when the ligaments on the outside of the ankle fail to heal properly after a sprain, leaving the ankle prone to repeated giving way, swelling, and pain during activity.

Reviewed byProf Paul Lee MBBch, FRCS (Tr & Orth), PhDLast reviewed 1 May 2026

Why sprains lead to instability

The lateral ankle ligaments (ATFL and CFL) are the primary restraints against the ankle rolling inward. A sprain stretches or tears these ligaments. If they heal in an elongated state, the ankle lacks the mechanical support to resist further sprains.

Repeated sprains progressively weaken the ligament complex.
Proprioceptive (balance) deficits develop alongside structural looseness.
Ongoing instability risks cartilage damage and early ankle arthritis.

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Treatment at London Cartilage Clinic

Treatment follows a step-wise approach starting with rehabilitation and progressing to surgery only when needed.

Proprioceptive and strength training to restore neuromuscular ankle control.
Bracing during sport for patients who improve with rehabilitation.
Ligament repair or reconstruction for persistent instability despite conservative treatment.

At arthroscopy, the joint is also assessed for cartilage damage that may have resulted from repeated instability events.

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You may have more options than you think

Most patients have more treatment options than they have been told

At London Cartilage Clinic we follow a structured clinical framework across four areas of treatment. Before recommending a single procedure, we assess which combination of approaches gives you the best outcome.

Preserve

Protect what you have. Slow degeneration and manage symptoms.

Repair

Fix specific damage. Torn tissue, unstable joints, structural problems.

Regenerate

Rebuild lost tissue. Biological treatments that stimulate new growth.

Replace

When other options are exhausted. Joint replacement as a last resort.

Explore the full range of treatments available for your joint. Each hub page shows every option we offer, organised by clinical approach.

Explore Ankle Options

Frequently Asked Questions

What causes chronic ankle instability?

It typically develops after one or more ankle sprains that damage the lateral ligaments. If the ligaments heal in a stretched or weakened state, the ankle remains prone to giving way, particularly on uneven surfaces.

Can physiotherapy fix ankle instability?

Many patients improve significantly with a structured programme focusing on proprioception (balance), peroneal muscle strengthening, and neuromuscular control. Surgery is reserved for those who remain unstable despite completing a thorough rehabilitation programme.

What does ankle ligament reconstruction involve?

The most common procedure is a modified Brostrom repair, which tightens and reattaches the stretched ligaments. For more severe cases, a tendon graft reconstruction may be needed to rebuild the ligaments entirely.

How long is recovery from ankle stabilisation surgery?

Patients typically wear a boot for two to four weeks and begin physiotherapy early. Return to running from three months and sport from four to six months, guided by functional testing.

Still have more specific concerns?

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London Cartilage Clinic

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