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
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.
Treatment follows a step-wise approach starting with rehabilitation and progressing to surgery only when needed.
At arthroscopy, the joint is also assessed for cartilage damage that may have resulted from repeated instability events.
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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.
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.
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.
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.
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