Chronic Ankle Instability Treatment and Exercises

Chronic ankle instability occurs when your ankle repeatedly “gives way.” This can occur after you initially sprain your ankle and it doesn’t heal correctly. Weak ligaments, decreased balance control, and altered biomechanics can make even simple movements feel unpredictable or painful.

However, the majority of ankle instability patients regain stability with proper rehabilitation, strengthening exercises, and bracing.

Treating chronic ankle instability involves restoring balance control and proprioception and preventing repeat injury before arthritis or joint degeneration sets in.

Why does chronic ankle instability occur?

A majority of ankle instability cases begin with an ankle sprain or multiple ankle sprains. The lateral ankle ligaments are commonly involved with instability, specifically the anterior talofibular ligament.

When these ligaments stretch or tear, they need time to heal. If they don’t heal properly, your ankle will lack mechanical stability.

Repeated ankle sprains also affect proprioception, the awareness your body has of joint position and how quickly muscles respond to movement. Weak proprioception means your muscles will respond more slowly to prevent future sprains. This can make you more prone to ankle sprains while walking or stepping on an uneven surface.

Degenerative arthritis and pain may also occur with chronic ankle instability.

What should I do if I reinjure my ankle?

Like with an initial ankle sprain, resting your ankle and RICE therapy will help reduce swelling and prevent further injury.

Elevation, ice, compression, and rest are your friends following reinjury. Try to resist the urge to walk it off or continue playing/sport. Continuing to put weight on the ankle right after reinjury can cause more damage to ligaments.

Consider bracing the ankle to provide stability while you move about. A supportive brace is usually preferred over complete immobilization with a wrap or splint.

Physical therapy and rehab exercises for ankle instability

Physical therapy and rehabilitation are key components to recovering from ankle instability. An ankle rehabilitation program should focus on strengthening muscles around the ankle, restoring balance control, and correcting movement patterns that will protect your ankle from future injury.

Often times strengthening exercises will target muscles of the periphery, calf muscles, and muscles that stabilize the foot.

Balance training also plays an important role in rehabilitating ankle instability since proprioception is often affected by repeated ankle sprains.

Doing single leg balance exercises, resistance exercises, wobble board exercises, and agility exercises help your body adjust to unstable surfaces and change of direction.

It’s important to stay consistent with these exercises over time rather than rushing through them. You should still be doing these exercises once your ankle feels better.

Bracing for ankle instability

Wearing an ankle brace is also beneficial when dealing with ankle instability. Not only can a brace help protect your ankle while it heals but they can also provide support when you return to physical activity.

Lace up ankle braces provide moderate support and allow for range of motion. Rigid ankle braces and hinged braces provide more support and may be helpful when participating in sports.

Braces are most beneficial when used in combination with ankle rehabilitation exercises. They do not make your ankle muscles weak.

Exercises for muscle imbalances and biomechanics

Poor biomechanics and muscle imbalances can affect the way you move your knee, hips, and lower back. Everything is connected.

Due to ankle instability, you may have weaknesses or compensation patterns that cause abnormal movement.

Foot mechanics, such as overpronation, can place extra stress on your ankles and lead to recurrent ankle sprains. Sometimes using orthotics or changing your shoes can help correct your posture and take stress off of your unstable ankles.

If your ankles are constantly giving out, it’s important to address poor movement habits before they cause injury elsewhere or develop into osteoarthritis.

Advanced non-surgical treatment options

If you continue to struggle with chronic ankle pain, your doctor may provide you with additional treatment options such as Platelet-Rich Plasma Injection.

This type of procedure and advanced rehabilitation may help promote healing of your ligaments and decrease chronic inflammation. Ligament strength and overall ankle function play a role in your ability to recover without surgery.

Surgery for chronic ankle instability

If several months of conservative management have failed, your doctor may discuss surgery with you. Surgical treatment is typically used when your ankle mechanically gives out on you.

The goal of surgery is to tighten the lateral ligaments that support your ankle. The procedure used is called the Brostrom Procedure.

In severe cases where ligaments are unable to be repaired directly due to tearing, doctors may need to utilize tendon grafts.

After surgery you will likely have your ankle immobilized for a short time period and then begin rehabilitation. You should be able to return to normal activities in a few months; however, recovery can take up to one year.

Recovery and preventing reinjury

Similar to an ankle sprain, recovery can take time. Your body must gradually rebuild strength and balance.

Even once you feel better, it’s important to continue performing your rehabilitation exercises.

Additionally, wearing shoes with good support, avoiding treacherous terrain early on, and continuing your proprioceptive exercises will decrease your chances of reinjury.

Preventing further injury to your ankle is key in not only relieving pain but also restoring confidence in your movement and preventing future joint degeneration.

Final Thoughts

After an ankle sprain goes improperly healed, you may develop chronic ankle instability. Ankle instability is characterized by your ankle giving way repeatedly.

The best way to recover from ankle instability is to incorporate physical therapy, strengthening exercises, proprioceptive training, bracing, and correcting movement mechanics.

If you begin having issues with your ankle early, you can prevent further injury and decrease your risk of arthritis in the future. When non-operative treatment fails, surgery can successfully restore stability to the ankle.

Frequently Asked Questions

Q: Can ankle instability go away on its own?

A: Sometimes yes. If you’ve had a recent ankle sprain, your ankle may feel unstable for a few weeks. The ligaments simply need time to heal. Chances are if you’ve experienced pain in your ankle for several months, your instability will not go away without treatment.

Q: Can you completely recover from chronic ankle instability?

A: With physical therapy, proprioception training, bracing, and time, yes! The majority of people who suffer from chronic ankle instability are able to recover and prevent future ankle sprains.

Q: How long does ankle instability last?

A: Every case is different, but you can expect a mild case of instability to improve in several weeks. More severe or chronic cases may take several months to feel better.

Q: What activities cause chronic ankle instability?

A: Any type of physical activity that increases your risk of ankle sprains can lead to chronic ankle instability. Sports such as basketball, soccer, trail running, and tennis are some of the highest-risk activities.