Ankle instability: Causes, clinical signs, and treatment options

Ankle instability is a common condition that can affect anyone, from professional athletes to those who have experienced a simple twist of the ankle. It occurs when the structures supporting the ankle (primarily ligaments) become weakened or damaged, leading to a feeling of the ankle “giving way.”

In this article, consultant orthopaedic surgeon Mr Barry Rose explores the main causes of ankle instability, the signs to look out for, and the treatment options available, helping patients understand this condition and when to seek professional care.

Causes of ankle instability

Several factors can contribute to ankle instability, including:

Acute injuries

The most frequent cause of ankle instability is a previous sprain or trauma. A sudden twist or roll of the ankle can stretch or tear the ligaments, reducing the ankle’s natural stability. Repeated injuries can worsen the problem, leading to chronic instability.

Ligament laxity

Some individuals naturally have looser ligaments, making their ankles more prone to instability even without major injury. This can be a congenital trait or develop over time, particularly in people who have had multiple ankle sprains.

Other factors

Age, muscle weakness, poor balance, and certain neurological conditions can all contribute to ankle instability. Footwear and uneven surfaces may also play a role in recurrent ankle injuries.

Recognising the clinical signs

Identifying the key symptoms of ankle instability can help determine the severity of the condition and guide appropriate treatment.

Feeling of the ankle “giving way”

A common symptom is the ankle suddenly giving way, especially on uneven ground or during physical activity. This may happen with minimal force, causing frequent sprains.

Pain and swelling

Patients often report pain around the outside of the ankle, particularly after activity. Swelling may occur immediately after an injury or persist with repeated episodes of instability.

Reduced function and confidence

Ankle instability can affect daily activities, making walking, running, or playing sports challenging. Some patients may notice reduced strength, balance problems, or difficulty returning to previous levels of activity.

Treatment options

Most cases of ankle instability initially respond to non-surgical treatments:

• Physiotherapy: exercises to strengthen muscles around the ankle and improve balance.
• Bracing or taping: provides extra support during activity.
• Activity modification: avoiding high-risk movements until strength and stability improve.

Surgical options

If instability persists despite conservative management, surgery may be considered. The most common procedures include:

1. Lateral ligament reconstruction: this involves repairing or tightening the damaged ligaments on the outside of the ankle to restore stability.
2. Tendon transfer: in some cases, a nearby tendon may be repositioned to support the ankle.
3. Arthroscopic procedures: minimally invasive surgery can remove scar tissue or repair small ligament injuries.

Surgical recovery typically includes physiotherapy to regain strength, mobility, and balance, ensuring the ankle returns to optimal function.

Ankle instability is a condition that can significantly impact daily life and sporting activities, but it is highly manageable with the right approach. By understanding the causes, recognising the clinical signs, and exploring both conservative and surgical treatment options, patients can take proactive steps towards recovery.