Why Does My Ankle Keep Giving Way After a Sprain? Chronic Ankle Instability Explained

Direct Answer

An ankle may keep giving way after a sprain because the ligaments remain mechanically loose, or because strength, balance and joint-position awareness have not fully recovered. These problems often occur together. Rehabilitation is usually the first-line treatment. Imaging may be appropriate when symptoms persist, the diagnosis is uncertain or tendon, cartilage or bone injury is suspected. Surgery is reserved for selected cases.

What is chronic ankle instability?

Chronic ankle instability describes persistent symptoms after one or more ankle sprains.

Possible features include:

• Recurrent episodes of giving way
• Repeated ankle sprains
• Lack of confidence on uneven ground
• Persistent outer-ankle pain
• Swelling after activity
• Difficulty running or changing direction
• Reduced balance
• A sense that the ankle cannot be trusted

The condition often develops after a lateral ankle sprain, in which the foot turns inward and injures the ligaments on the outside of the ankle.

Not everyone who has had several sprains has the same underlying problem. Treatment depends on whether instability is mainly mechanical, functional or associated with another injury.

What is the difference between mechanical and functional instability?

Mechanical instability

Mechanical instability means that the ligaments or joint structures provide insufficient physical restraint.

Possible findings include:

• Increased ligament laxity
• Excessive movement during examination
• Widening on selected stress imaging
• Recurrent sprains during turning or landing
• A history of substantial ligament injury

Functional instability

Functional instability describes a feeling of giving way related to how the neuromuscular system controls the ankle.

Possible contributors include:

• Reduced balance
• Slower muscle reactions
• Impaired proprioception
• Weakness
• Reduced confidence
• Poor landing or change-of-direction control
• Incomplete rehabilitation

Combined instability

Many patients have both mechanical and functional components.

A loose ligament does not guarantee symptoms, and an ankle can feel unstable without major ligament laxity. This is why examination and functional testing matter.

Why does the ankle give way after a sprain?

The ligament has not regained sufficient stability

A moderate or severe sprain can stretch or tear one or more lateral ligaments.

The most commonly involved are:

• Anterior talofibular ligament
• Calcaneofibular ligament

Some injuries heal with residual laxity, particularly after repeated sprains.

Proprioception remains impaired

Proprioception is the body’s awareness of joint position and movement.

Ligament injury can disrupt sensory feedback from the ankle. The muscles may not respond quickly enough when the foot begins to roll on uneven ground.

The ankle may then give way even if ordinary walking on a smooth surface feels normal.

Strength has not been restored

The muscles around the ankle, calf, hip and trunk contribute to balance and control.

Weakness or reduced endurance may become apparent during:

• Prolonged walking
• Running
• Jumping
• Landing
• Cutting or pivoting
• Uneven terrain
• Late stages of a match or training session

Rehabilitation stopped when the pain improved

Pain and swelling often settle before balance, reaction time and sport-specific capacity have recovered.

A person may return to activity because the ankle no longer hurts during daily walking, even though it is not ready for unpredictable or high-speed demands.

Another injury was overlooked

Persistent giving way may also occur with:

• Peroneal tendon injury
• Osteochondral lesion of the talus
• Ankle impingement
• Syndesmotic injury
• Previous fracture
• Subtalar-joint instability
• Loose body
• Nerve dysfunction
• Generalised joint hypermobility

The diagnosis should be reassessed when rehabilitation does not produce the expected progress.

Is “giving way” always true ligament instability?

No.

The ankle may suddenly buckle because of:

• Pain inhibition
• Muscle fatigue
• Reduced balance
• Nerve dysfunction
• Fear or loss of confidence
• A mechanical block
• Another lower-limb condition

A careful description of the event is useful.

Questions may include:

• Does the ankle actually roll?
• Is there sudden pain before it gives way?
• Does it happen only on uneven ground?
• Does the person fall?
• Is numbness present?
• Does the knee or hip also buckle?
• Does the ankle swell afterward?

The answers can change the diagnostic direction.

What symptoms suggest another injury?

Features that may warrant broader assessment include:

• Deep pain inside the ankle
• Catching or locking
• Painful clicking
• Persistent focal bone tenderness
• Pain above the ankle
• Snapping behind the outer ankle
• Significant weakness
• Numbness or tingling
• Recurrent swelling
• Inability to progress running or jumping
• Pain that is becoming worse rather than better

These symptoms do not prove that another injury is present, but they may justify reassessment or imaging.

How is chronic ankle instability assessed?

Injury history

The clinician may ask:

• How did the first sprain occur?
• How many subsequent sprains have occurred?
• Did the ankle become substantially swollen or bruised?
• Could the person bear weight?
• Was imaging performed?
• Was the ankle immobilised?
• What rehabilitation was completed?
• Which activities now cause giving way?

A history of repeated sprains without progressive rehabilitation may strongly influence the treatment plan.

Ligament examination

Selected tests may assess movement of the talus relative to the lower leg.

Examples include tests intended to assess:

• Anterior talofibular ligament laxity
• Calcaneofibular ligament laxity
• Syndesmotic stability

No single test proves or excludes chronic instability. Pain, muscle guarding and examiner technique affect the findings.

Strength assessment

Testing may include:

• Foot eversion strength
• Inversion strength
• Calf raises
• Toe and foot-muscle function
• Hip strength
• Endurance
• Comparison with the other side

Balance and functional testing

Possible tests include:

• Single-leg standing
• Standing with reduced visual input
• Reaching while balancing
• Single-leg squat
• Hopping
• Landing
• Change-of-direction tasks
• Running drills

The testing should match the patient’s stage of recovery. High-demand hopping is not appropriate for every painful ankle.

Is an X-ray necessary?

Not everyone with chronic instability needs an X-ray, but radiography may be appropriate when persistent pain or repeated injury requires structural assessment.

X-rays may show:

• Previous or unhealed fracture
• Arthritis
• Bone spurs
• Joint alignment
• Osteochondral abnormalities
• Other bone changes

Stress radiographs may be used in selected cases to assess mechanical laxity, although their role depends on the clinical context and local practice.

A normal X-ray does not exclude ligament, tendon or cartilage injury.

When is ultrasound useful?

Musculoskeletal ultrasound can assess:

• Lateral ankle ligaments
• Peroneal tendons
• Tendon movement or subluxation
• Superficial soft-tissue abnormalities
• Dynamic changes during movement

It can also compare the affected and unaffected sides.

Limitations include operator dependence and reduced ability to comprehensively assess deeper cartilage and bone structures.

When is MRI useful?

MRI may be considered when:

• Pain remains persistent
• Rehabilitation has not restored stability
• An osteochondral lesion is suspected
• A tendon tear may be present
• The symptoms are not fully explained by ligament instability
• Surgery is being considered
• Recurrent swelling, catching or locking occurs
• Another structural injury needs assessment

MRI can evaluate the ligaments, tendons, cartilage, bone marrow and other tissues.

However, a ligament that looks abnormal on MRI does not automatically require surgery. The finding must correspond to symptoms, examination and functional instability.

The American College of Radiology generally recommends radiographs as initial imaging for chronic ankle pain, followed by MRI, ultrasound or other imaging based on the suspected condition. ACR Appropriateness Criteria: Chronic Ankle Pain

What is the main treatment?

Progressive rehabilitation is generally the first-line treatment.

The programme should address the deficits identified rather than rely on rest alone.

Balance and proprioception training

Exercises may progress from:

• Double-leg standing
• Single-leg standing
• Reaching while balancing
• Unstable or uneven surfaces
• Movement with reduced visual input
• Catching or throwing tasks
• Sport-specific reactive drills

The objective is to improve the body’s ability to detect and respond to unexpected movement.

Strengthening

Rehabilitation may target:

• Peroneal muscles
• Calf muscles
• Muscles supporting the foot
• Hip abductors and extensors
• Trunk control
• Overall lower-limb strength

Resistance, speed and complexity can be increased progressively.

Range-of-motion work

Restricted ankle dorsiflexion may affect walking, squatting, landing and stair use.

Treatment may include mobility exercise or selected manual therapy when a relevant restriction is present.

Running, hopping and landing

Later rehabilitation may include:

• Jogging
• Acceleration and deceleration
• Hopping
• Landing
• Cutting
• Pivoting
• Uneven-ground practice
• Sport-specific drills

Returning to sport without this stage may leave the athlete unprepared despite being pain-free during ordinary walking.

The 2021 lateral ankle sprain clinical practice guideline recommends proprioceptive and neuromuscular exercise for chronic ankle instability rather than external support alone. JOSPT Clinical Practice Guideline

How long should rehabilitation take?

There is no universal duration.

A useful programme should be long enough to produce measurable changes in:

• Balance
• Strength
• Confidence
• Hopping ability
• Change-of-direction control
• Walking or running tolerance
• Frequency of giving-way episodes

A few sessions of pain-relieving treatment without functional progression may be insufficient.

If an appropriately delivered programme produces no meaningful improvement, the diagnosis and treatment strategy should be reviewed.

Should an ankle brace be used?

A brace or taping may reduce the risk of recurrent sprain in selected people, particularly during higher-risk activity.

It may be useful for:

• Returning to sport
• Walking on uneven terrain
• Work involving unpredictable surfaces
• Activities with repeated cutting or jumping
• The early transition from rehabilitation to full activity

A brace does not necessarily weaken the ankle when used appropriately, but it should not replace strength and balance training.

Long-term dependence without rehabilitation may leave functional deficits unaddressed.

Is taping better than a brace?

Neither is universally better.

Taping

Possible advantages:

• Customisable
• Low profile
• Familiar to many athletes

Possible limitations:

• Support may decrease during activity
• Skin irritation
• Requires repeated application
• Ongoing cost and technique dependence

Bracing

Possible advantages:

• Reusable
• Consistent application
• Adjustable
• Easier for self-management

Possible limitations:

• Bulk inside footwear
• Discomfort
• Restriction if fitted poorly
• Not suitable for every task

The choice depends on comfort, sport, footwear and the degree of support required.

Does manual therapy help?

Manual therapy may provide short-term improvement in ankle movement and symptoms, particularly when dorsiflexion is restricted.

It does not replace neuromuscular exercise, strength training and functional progression.

If the ankle continues to give way despite repeated manual treatment, reassessment is needed rather than assuming that the joint repeatedly “goes out of place.”

Does shockwave therapy treat instability?

Shockwave therapy is not a primary treatment for ligament instability.

It may be considered for certain chronic tendon conditions around the ankle, but those are different diagnoses.

Shockwave does not mechanically tighten a loose ankle ligament or restore balance by itself.

Are injections useful?

Injections are not routine treatment for uncomplicated chronic ankle instability.

An injection may be considered when a specific coexisting condition is identified, but it does not restore:

• Ligament tension
• Proprioception
• Strength
• Reaction time
• Landing control

Corticosteroid injections near tendons and ligaments also require careful risk assessment.

PRP and other biologic injections have been proposed for ligament problems, but evidence is limited and inconsistent. They should not be described as proven ligament regeneration.

When is surgery considered?

Surgical assessment may be reasonable when:

• Recurrent giving way persists
• Mechanical laxity is clinically significant
• A comprehensive rehabilitation programme has not restored acceptable stability
• The instability substantially limits work, sport or daily life
• Imaging and examination identify a surgically addressable problem
• Associated tendon, cartilage or bone pathology requires consideration

Surgery should not be recommended solely because MRI shows an old ligament tear.

What surgery may be performed?

A common approach is anatomical lateral ligament repair or reconstruction.

A Broström-type procedure generally aims to repair or tighten the damaged lateral ligaments.

Other procedures may be considered when:

• Tissue quality is poor
• Previous repair has failed
• Generalised laxity is present
• Deformity contributes to instability
• A tendon or osteochondral lesion also requires treatment

The operation should be selected according to the individual anatomy and associated injuries.

Does surgery permanently prevent further sprains?

No procedure can guarantee that another sprain will never occur.

Potential benefits include:

• Improved mechanical stability
• Fewer giving-way episodes
• Improved confidence
• Better function

Potential risks include:

• Infection
• Nerve irritation
• Stiffness
• Persistent pain
• Recurrent instability
• Over-tightening
• Wound problems
• Blood clots
• Need for additional surgery

Postoperative rehabilitation remains necessary.

When can someone return to sport?

Return should be based on readiness rather than time alone.

Relevant factors include:

• Pain
• Swelling
• Ankle movement
• Strength
• Balance
• Hopping
• Landing
• Change-of-direction ability
• Sport-specific performance
• Confidence
• Recovery after training

An athlete who can run straight ahead may not yet be ready for cutting, contact or unpredictable landing.

What if the ankle still gives way despite physiotherapy?

Reassessment may ask:

• Was mechanical laxity assessed?
• Was the rehabilitation progressed beyond basic balance exercises?
• Were strength and endurance measured?
• Were hopping and change-of-direction tasks included?
• Is a peroneal tendon injury present?
• Could there be an osteochondral lesion?
• Is the instability arising from the subtalar joint?
• Does nerve dysfunction contribute?
• Would imaging change management?
• Is an orthopaedic opinion now appropriate?

A failed generic programme does not prove that all non-surgical treatment has failed. Conversely, repeating the same low-level exercises indefinitely is not a complete solution.

When should a second opinion be considered?

A second opinion may be useful when:

• Surgery is proposed without comprehensive rehabilitation
• Persistent giving way is attributed only to weakness despite clear laxity
• Symptoms and MRI do not match
• Pain, locking or swelling suggests another injury
• Several sprains have occurred despite treatment
• Different operations have been proposed
• The patient remains uncertain about the balance between bracing and surgery

The purpose is to clarify the cause and available options.

When does ankle instability require prompt assessment?

Seek timely medical attention for:

• Inability to bear weight after a new injury
• Obvious deformity
• A cold, pale or numb foot
• Rapidly increasing swelling
• Severe escalating pain
• A hot, red and swollen joint with fever
• New significant weakness
• Persistent locking
• Calf swelling with chest pain or breathlessness
• An open wound over a suspected fracture

These features require assessment beyond routine instability rehabilitation.

Practical considerations in Singapore

Assessment may begin through a polyclinic, general practitioner, private medical clinic or physiotherapy provider.

Depending on the presentation:

• X-rays may assess bone, alignment and arthritis.
• Ultrasound may assess lateral ligaments and peroneal tendons dynamically.
• MRI may assess ligaments, cartilage, tendons and occult bone injury.
• Physiotherapy may address strength, balance and activity-specific control.
• Bracing may support selected higher-risk activities.
• Referral to an orthopaedic service may be appropriate when instability remains disabling despite comprehensive rehabilitation.

Insurance policies differ in their referral, imaging and pre-authorisation requirements. Patients intending to claim should verify the terms of their policy.

Frequently Asked Questions

Why does my ankle give way even when it no longer hurts?

Pain may settle before proprioception, strength and reaction time have recovered. Functional instability can remain even when ordinary walking is comfortable.

Does a torn ankle ligament heal?

Many ligament injuries heal sufficiently for good function. Some heal with residual laxity, while others remain stable despite an abnormal imaging appearance.

Can balance exercises tighten a loose ligament?

They do not physically shorten the ligament, but they can improve neuromuscular control and reduce giving-way episodes. Mechanical and functional stability are related but not identical.

Must I wear a brace forever?

Not necessarily. Some people use a brace only during high-risk activities, while others stop after rehabilitation. The decision depends on recurrence risk and confidence.

Is MRI required before physiotherapy?

Usually not. Rehabilitation can often begin based on clinical assessment. MRI may be considered when symptoms are atypical, progress is limited or another injury is suspected.

Does repeated ankle cracking mean instability?

No. Joint sounds alone do not diagnose instability. Recurrent giving way, sprains, laxity and functional deficits are more relevant.

Can I run with chronic ankle instability?

Running may be possible when straight-line control and tolerance are adequate. Trail running, cutting and jumping require additional balance and reactive control.

How many sprains are too many?

There is no fixed number. One severe sprain with persistent giving way may warrant assessment, while several minor sprains suggest that rehabilitation and mechanical stability should be reviewed.

When is surgery appropriate?

Surgery may be considered when clinically significant mechanical instability continues to limit function despite comprehensive rehabilitation and the findings identify a repairable problem.

Will surgery eliminate the need for rehabilitation?

No. Rehabilitation is required after surgery to restore movement, strength, balance and confidence.

References

• Martin RL, et al. Lateral Ankle Ligament Sprains: Revision 2021 Clinical Practice Guideline. Journal of Orthopaedic & Sports Physical Therapy. 2021.
• American College of Radiology. ACR Appropriateness Criteria: Chronic Ankle Pain.
• American Academy of Orthopaedic Surgeons. Sprained Ankle.
• Vuurberg G, et al. Diagnosis, treatment and prevention of ankle sprains: an evidence-based clinical guideline. British Journal of Sports Medicine. 2018.
• Michels F, et al. ESSKA-AFAS international consensus on chronic lateral ankle instability. Knee Surgery, Sports Traumatology, Arthroscopy. 2018.

This article is for general education and does not replace an individual medical or surgical assessment. Diagnosis and treatment depend on symptoms, examination findings, imaging where appropriate, medical history and personal circumstances. Urgent warning symptoms require prompt medical care. Evidence for biologic and emerging procedures may still be developing, regulatory status varies, and some treatments may not be approved or routinely recommended in Singapore.

If an ankle repeatedly gives way, continues to swell or has not improved with rehabilitation, medical reassessment may help determine whether the problem is functional instability, ligament laxity or another tendon, cartilage or bone injury. The Pain Relief Clinic provides assessment by a licensed medical doctor, access to imaging where medically appropriate and in-house physiotherapy for integrated management.

Call or WhatsApp: +65 9068 9605

Reviewed by Dr Terence Tan, Founder of The Pain Relief Clinic — 19 September 2026