Chronic Ankle Sprain & Ankle Instability

An ankle sprain occurs when one or more ligaments of the ankle are stretched or torn, usually following a sudden twisting or rolling injury. Ankle sprains are among the most common musculoskeletal injuries and account for approximately 40% of all traumatic ankle injuries.

They commonly occur during:

• Sport and recreational activities

• Running and jumping

• Rapid changes in direction

• Walking on uneven surfaces

When an Ankle Sprain Does Not Fully Recover

For some people, an ankle sprain does not heal completely. This can lead to chronic ankle instability, where the ankle feels weak, unstable, or repeatedly "gives way."

Over time, chronic ankle instability may contribute to:

• Recurrent ankle sprains

• Ongoing ankle pain

• Reduced balance and confidence

• Joint stiffness

• Post-traumatic arthritis

• Changes in walking pattern (gait)

• Increased strain on the knees, hips, and lower back

Common Symptoms

Symptoms may include:

• Pain on the outside of the ankle

• Pain on the inside (medial side) of the ankle due to injury of the deltoid ligament, spring ligament, or supporting structures

• Swelling

• Weakness or instability

• Recurrent ankle sprains

• Tenderness around the ankle

• Difficulty running, jumping, or changing direction

• Pain when walking on uneven ground or descending slopes

• Pain after prolonged standing or sitting with legs folded underneath the body

Possible Conditions Associated with Chronic Ankle Sprains

Lateral (Outside) Ankle Pain

• Chronic ankle instability

• Sinus Tarsi Syndrome

• Peroneal tendon injuries

• Lateral ligament injuries

• Post-traumatic arthritis

Medial (Inside) Ankle Pain

• Deltoid ligament injury

• Posterior Tibial Tendon Dysfunction (PTTD)

• Spring ligament injury

• Tarsal Tunnel Syndrome

• Medial ankle instability

• Medial subtalar instability

Assessment

A podiatrist may assess:

• Previous ankle injuries

• Ligament stability

• Foot posture and biomechanics

• Walking and running pattern

• Balance and strength

• Areas of tenderness and swelling

Imaging such as X-ray, ultrasound, or MRI may be recommended when necessary.

Treatment Options

Conservative Management

Most patients improve with non-surgical treatment:

• Activity modification

• Physical therapy and rehabilitation

• Strengthening and balance exercises

• Ankle bracing or taping

• Orthotic therapy and footwear modifications

• Ice and anti-inflammatory measures

• Prolotherapy or Platelet-Rich Plasma (PRP) injections in selected cases

Surgical Management

Surgery may be considered when significant ligament damage or chronic instability persists despite appropriate conservative care.

Surgical options may include:

• Ligament repair

• Ligament reconstruction

• Arthroscopic surgery

• Joint stabilization procedures

The Role of Your Podiatrist

Podiatrists play an important role in:

• Diagnosis and assessment

• Early treatment

• Rehabilitation programs

• Orthotic prescription

• Footwear advice

• Injury prevention strategies

• Long-term management of chronic ankle instability

Prognosis

Early diagnosis and appropriate treatment can help restore stability, reduce pain, and minimise the risk of future ankle problems and arthritis.

If you experience persistent ankle pain, instability, or recurrent sprains, a professional assessment is recommended.