What Causes Ankle Instability, and When Does It Need Surgery?
If you’ve rolled or sprained your ankle more than once, or feel like it’s going to give way during everyday activities or sport, you may be dealing with chronic ankle instability rather than a simple sprain. Understanding what’s driving it helps determine whether non-surgical treatment is enough, or whether surgery should be considered.
What Is Ankle Instability?
Ankle instability describes a persistent feeling of the ankle giving way, rolling, or feeling unreliable during everyday activities or sport, usually following one or more previous ankle sprains. It’s different from an acute sprain, which is a single injury event; instability is an ongoing pattern that continues well after the original injury should have healed.
What Causes Ankle Instability?
Several factors can contribute to ongoing ankle instability, including:
Repeated ankle sprains that haven’t fully healed
Incomplete rehabilitation after an initial sprain
Weakness in the muscles surrounding the ankle
Reduced proprioception, or the joint’s sense of its own position, following injury
Underlying joint laxity or anatomical factors, in some patients
When Is Surgery Necessary?
Not every case of ankle instability needs surgery. Many people improve significantly with a structured non-surgical program, which typically includes:
Balance and proprioception (neuromuscular) training
Strengthening exercises for the muscles around the ankle
Bracing or taping during sport or higher-risk activities
Physiotherapy-guided rehabilitation over a period of months
Surgery may be recommended when instability continues despite several months of dedicated non-surgical treatment, when the ankle keeps giving way and affecting daily activities or sport, or when imaging shows significant ligament damage that is unlikely to respond to rehabilitation alone.
What Does Surgery Involve?
Surgery for chronic ankle instability most commonly involves reconstructing or tightening the damaged ligaments, a procedure often referred to as a lateral ligament repair or reconstruction. In some cases, this can be performed using minimally invasive techniques, depending on the extent of the damage and your individual anatomy.
Dr Janan’s Approach
Dr Janan Chandrananth trained in foot and ankle surgery during fellowships in Bristol (UK) and Tokyo, including under Professor Satoru Ozeki, a past president of the Japanese Society for Surgery of the Foot. This international training gives him a broad perspective on both non-surgical rehabilitation and surgical reconstruction techniques for ankle instability.
During your consultation, Dr Janan will assess your ankle’s stability, review any previous imaging, and discuss your goals and activity level to recommend whether continued non-surgical management or surgery is the right path forward.
Key Takeaways
Ankle instability is a persistent giving-way pattern, different from a one-off sprain
Repeated sprains, incomplete rehab, and muscle weakness are common contributing causes
Most people improve with a structured non-surgical program of balance, strength and bracing work
Surgery is generally considered only after non-surgical treatment hasn’t resolved ongoing instability
Ready to discuss your treatment options?
Book a consultation with Dr Janan Chandrananth to have your ankle properly assessed and discuss whether non-surgical management or surgery is the right path forward for you.
Related reading: Ankle Ligament Injury
