Chronic Ankle Instability (Repeat Ankle Sprainer, Unstable Ankle)

Updated: Oct 7, 2019

Cause: Hereditary (loose ligaments, high arch foot), incomplete rehab from original injury, previous ankle fracture

Appearance: Twisting injury with sudden pain and limp. Bruising and swelling, difficulty walking.

How to Diagnose: X-ray to rule out fracture/dislocation, clinical exam (anterior drawer and talar tilt test). MRI will help show which ligaments are involved and severity.


- Treatment is centered around establishing stability to the ankle

o Rest, Ice, Elevation

o Physical therapy

o Brace/Taping for tennis

o Brace/tape with tennis for 3 weeks

o High lateral flanged orthotics

- Special consideration should be given to secondary surgical repair

o For single ligament instability

§ Tightening and repair of the ligament with stitching ( Brostrom procedure)

§ Consideration should be given to a reinforcing with synthetic graft.

o For multiple ligament instability

§ Tendon graft to recreate multiple ligaments (Christman-Snook procedure)

Long-term prognosis: Chronic ankle instability is just that, chronic. Bracing and taping can be a permanent solution in athletes that are not surgical candidates. Single ligament repair usually rehabs in 6-8 weeks. Multiple ligament repair produces significant stiffness for months to years after surgery and can be permanent. Every attempt should be made to prevent the sprain as this is easier to manage than rehabing a sprained ankle. Tennis shoes with a wider lateral flange enhance side to side stability. A hot hard court can be a hazard if the rubber of the tennis shoe is sticking, therefore caution should be taken in higher temperature conditions.

Who to call: Podiatrist, orthopedic surgeon

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