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Ankle Sprains & Instability

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A twisting injury causing inversion of the foot and ankle is the most common mechanism, producing a spectrum of injuries to the lateral ankle ligaments. These injuries are particularly common in running sports such as football, basketball, and netball. Most ankle sprains (80%) recover completely with conservative treatment.

What Happens in a Bad Sprain?

A severe sprain causes tearing or rupture of the lateral ligaments (ATFL and CFL). These ligaments heal but often in a stretched position, causing the ankle to feel unstable and increasing the risk of further sprains. Repeated sprains can damage the ankle joint surface and, over 20–30 years, lead to ankle arthritis.

Symptoms of Chronic Instability

• Ankle feels weak or untrustworthy
• Difficulty walking on uneven terrain
• Discomfort with sudden starting and stopping
• Pain and swelling with increased activity
• Recurrent giving way of the ankle

Non-Surgical Management

• Active physiotherapy — soft tissue massage, range of motion exercises
• Peroneal muscle strengthening
• Proprioceptive retraining
• Ankle bracing

Surgery — Lateral Ligament Reconstruction

If instability persists after 3–4 months of physiotherapy, surgery is indicated. The aim is to restore the length of the elongated ATFL and CFL ligaments, performed through a small 2 cm incision as a day case. Following surgery, weight-bearing in a walker boot for 2 weeks is typically possible, followed by an ankle brace. Physiotherapy commences at 2 weeks, allowing rapid return to function. Light jogging may begin at 6 weeks.

Potential Complications of Untreated Instability

• Osteochondral (cartilage) damage to the ankle joint
• Anterior or posterior ankle impingement
• Peroneal tendon tears or subluxation
• Development of ankle arthritis over time