Ankle Keeps Giving Out (Chronic Ankle Instability): Symptoms, Causes & PT Treatment
Updated October 20261 minute read
Chronic ankle instability means your ankle repeatedly gives way or feels unreliable, usually after one or more sprains that weren't fully rehabbed. The good news: physical therapy — especially balance and strengthening training — is highly effective and the cornerstone of treatment. Surgery is reserved for cases that don't respond. Restoring balance and strength is what stops the cycle of repeat sprains.
What is chronic ankle instability?
It's a pattern of recurrent giving way and repeated sprains, driven by a combination of stretched ligaments and — importantly — lost balance and strength after the original injury.
Symptoms
Common features are a sense the ankle might "roll" or give way, repeated sprains, a feeling of weakness or unreliability on uneven ground, and sometimes lingering swelling or discomfort.
What causes it / risk factors
Prior ankle sprains (especially poorly rehabbed ones), reduced balance and proprioception, and weakness of the ankle stabilizers.
How it's diagnosed
A clinician assesses ligament laxity, strength, and balance, and reviews your sprain history.
Physical therapy treatment
What a PT does. Your therapist rebuilds the balance, proprioception, and strength that prevent the ankle from giving way. Exercises & progression (overview). Balance/proprioception training, ankle and hip strengthening, and graded return to dynamic activity. Balance training is strongly supported for reducing recurrent sprains. Recovery timeline. Many people improve over several weeks of consistent training.
Treatment options compared
PT (especially balance training) is first-line. Bracing or taping can support activity. Surgery is reserved for instability that doesn't respond to rehab.
Red flags
Seek prompt care for an acute severe sprain with inability to bear weight and bony tenderness (possible fracture), or a hot feverish joint.
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Frequently asked questions
Usually lost balance and strength after prior sprains, not just loose ligaments.
Sources (5)
- Martin RL, et al. Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains Revision 2021. J Orthop Sports Phys Ther. 2021. — PubMed
- Doherty C, et al. Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis. Br J Sports Med. 2017. — PubMed
- AAOS OrthoInfo: Sprained Ankle. — AAOS OrthoInfo
- de Vries JS, et al. Interventions for treating chronic ankle instability. Cochrane Database Syst Rev. 2011. — Cochrane
- Vuurberg G, et al. Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. Br J Sports Med. 2018. — BJSM
This article is for education only and isn't medical advice. Always talk to a licensed clinician about your specific situation.