Unstable Ankle

What is it?

The ankle joint is not a simple hinge and moves in many directions held by some very complex ligaments. When you go over your ankle you can injure one or more of these ligaments. Low-grade injuries can heal by themselves but more severe injuries can become recurrent and make you conscious of your ankle and worried that it may give way even on simple activities.

What causes it?

The most common cause of ankle instability is previous injuries. I believe that even low-grade ankle sprains should go through a focussed period of balance training to strengthen the ankle and stop it from happening again but in some cases, even a single severe ankle sprain can lead to ongoing instability that can only really be improved by surgery.

How can I treat it?

Over 90% of simple ankle sprains can be improved massively by appropriate strengthening and balance training. We call this proprioceptive rehabilitation. I recommend this treatment with a specialist foot and ankle physiotherapist that I can arrange to ensure you give your ankle the best chance at recovery.

At least 10% of patients develop instability of the ankle or “micro-instability” which is pain and occasional feelings of giving way when doing activities. If this is the case and an MRI proves injury to your ankle ligaments, I would consider surgical repair.

What does surgery involve?

I utilise 2 main surgical techniques to repair ankle ligaments. The first is the repair of the ligaments using keyhole surgery. This is not yet commonplace in the UK, however, I have learned the techniques from some of the top European surgeons and I believe it gives good outcomes with minimal soft tissue damage leading to a quick recovery.

​A more reliable technique for very longstanding deformities and possibly a better option for high level athletes is what is known as an internal brace. After camera keyhole surgery and proper assessment of the damage a 4 cm cut is made over the ligaments. The ligaments are repaired to their original position and then a 2mm thick tape is fixed with small plastic screws to the ankle and foot bones.

This protects the ligament while it heals as if you were wearing an ankle brace support. I use this for redo surgery and if you have a strong preference. We will discuss options in detail if we feel that surgery is appropriate.


Aftercare is similar for both procedures. You wear a bandage and boot for 2 weeks after which we start physiotherapy. Return to full sports is usually around 3 months for an internal brace and 4-6 months for an arthroscopic repair.

Risks and complications

There are risks to all surgery and conservative measures should be tried when possible. If surgery is an option, we will discuss all of the pros and cons and the risks that are specific to you in detail.

Recurrence is likely to be higher after an arthroscopic repair especially if you injure the ankle again soon after surgery, but we are very careful with therapy and sport-specific rehab to avoid this. If there is a recurrence an internal brace is always an option.

The internal brace requires a slightly bigger operation and there is a small risk of the small plastic screws damaging the ankle joints as they are inserted. In high-level athletes or dancers, there are some concerns that an internal brace can lead to a feeling of over-tightness and restrict movement. In the clinic, we will discuss all options and decide which is best for you.