Ankle

Chronic Ankle Instability

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You sprained your ankle a year ago, maybe longer. The swelling went, the bruise faded and you got on with things. But the ankle never quite trusted itself again. It goes over on a gutter, on uneven grass, stepping down off a ladder, and each time you wonder whether this is just how it is now. It usually isn't. But it rarely sorts itself out by waiting.

What's actually causing it

When a sprain doesn't heal properly, the ankle can be left feeling weak and unstable, and prone to giving out ¹. Researchers generally describe chronic ankle instability as more than 12 months past the first sprain, with a tendency to re-sprain, repeated episodes or feelings of the ankle giving way, and ongoing symptoms such as pain, swelling, limited movement, weakness or reduced function ².

Three kinds of change tend to be going on at once ²:

Mechanical: physical changes in the ligaments and the joint after the injury.
Sensory: changes in how the ankle senses and perceives its own position.
Movement: changes in how the muscles control and protect the ankle as you move.

All of that sits inside the bigger picture of your confidence, your activity and the rest of your life ². It's why two people with the same sprain history can end up with very different ankles.

The common thread is rehabilitation. When functional rehab after a sprain doesn't succeed, chronic instability is the usual result ⁴. Resting until it stops hurting gets you a pain-free ankle. It doesn't necessarily get you a stable one.

Man balancing on one leg with the loose ligaments on the outer ankle shown

A fresh sprain or chronic instability? How to tell the difference

A single ankle sprain and chronic ankle instability are related but different problems ³. Most people's sprain symptoms settle. Where complaints of instability keep going, that's what gets called chronic ankle instability ³.

A rough guide:

A recent sprain: one clear injury, with pain and swelling that are gradually improving.
Chronic instability: more than a year since the first sprain, repeated rolls or near-misses, and an ankle you don't quite trust on uneven ground ².

There's a second distinction inside chronic instability itself. An ankle can be functionally unstable, meaning it feels and behaves unstable, or mechanically unstable, meaning the ligaments are measurably looser. Telling the two apart guides treatment ⁴, and it's something an assessment answers, not something you can judge at home.

How it's diagnosed

Mostly from your history and a hands-on examination. The unstable feeling is judged from what you report, and looseness in the ligaments from examining the ankle ⁴. A clinician asks about past sprains, including any bad roll, and about the ankle giving way or feeling like it might. By definition that has gone on for more than 12 months since the first injury ³ ⁴.

Then comes your foot shape: does the heel tilt inwards, is the arch high ⁴? They test the strength of the muscles down the outside of your lower leg and check your balance, because the ankle's sense of its own position is commonly off ⁴. They also look for problems that often travel with instability, such as irritated tendons behind the outer ankle bone ⁴.

How we treat it

A proper assessment first. Hands-on tests such as the anterior drawer and varus stress tests help show how much mechanical looseness there is ⁴. We also check the joint just below the ankle (the subtalar joint), because instability there is often missed ⁴.

Sports physiotherapy: the exercise program. Balance, strengthening and functional exercises are the core of physio for this condition ¹. A 2026 review of 48 trials and 1,630 people found every type of exercise studied, including balance, strength, combined and jump-based training, improved dynamic balance. Most also improved people's own rating of how their ankle functions ⁵. One caveat: the authors rate the certainty of that evidence as very low, and it doesn't reliably rank one type above another ⁵. So we build the program around your ankle and what you need it to do, not around a single "best" protocol.

Manual therapy for stiffness. Limited movement is one of the ongoing symptoms ², and hands-on treatment is one way we work on it alongside the exercises. To be plain about it: none of the research cited on this page tests hands-on treatment for chronic instability, so it supports the exercise work and doesn't replace it.

Other treatments we may use

Bracing and taping.

A brace or tape is a reasonable way to protect the ankle, especially for athletes or after a recent sprain ¹. Sports taping can help you get through training or a season while the rehab takes hold. Keep expectations modest, though. A review of kinesio taping in chronic ankle instability found only small balance gains in some directions, no difference on several other measures, and concluded it shouldn't replace strengthening and balance training ⁶.

A surgical opinion.

Unlike a first sprain, chronic ankle instability sometimes needs surgery. That usually means repairing the ligaments, sometimes reinforced using tendon, and it's increasingly done arthroscopically (keyhole surgery) ⁴. That's a decision for an orthopaedic surgeon, not something we perform. If a solid rehab program hasn't settled clear mechanical looseness, we'll talk with you and your GP about a referral.

Your recovery path: Reset, Rebuild, Return

An ankle that keeps giving way is not a fresh injury, so The Well Motion Recovery Path™ starts differently here. You still move up a phase on what the ankle can do, never on a date.

Reset: the first visit or two. This phase is mostly the assessment: is the instability mainly functional or mechanical ⁴. A brace or sports taping can protect the ankle meanwhile ¹. We move you on once we know what we are training and everyday walking feels comfortable.
Rebuild: most of the work. The balance, strength and functional exercise program ¹, with manual therapy if stiffness is holding you back. Expect strength to come back before trust does. We move you on when the ankle stays steady through what your daily tasks ask of it.
Return: whatever you have been avoiding: uneven ground, ladders, running, sidestepping. We test those tasks before you go back. You leave with balance work to keep going ⁷ and, for sport, a brace ⁸.

How long it usually takes. There is no single recovery time. The exercise trials pooled in one review ran 4 to 12 weeks, most of them 4 to 6, and its authors rate the certainty of that evidence as very low ⁵. If it comes to surgery, the surgeon sets the timeline. In one study of 62 people, with no randomisation, return to sport averaged about 10 weeks after ligament repair and 14 after reconstruction ¹⁰.

Reducing the risk of flare-ups

With this condition a flare-up usually means another roll. The trials below were run in people who'd sprained an ankle before, not in people diagnosed with chronic instability. It's the closest tested evidence there is:

Keep the balance work going. Balance training cut repeat sprains by about a third in people with a previous sprain ⁷. Short programmes with little equipment still helped, and nobody has pinned down the best dose ⁷.
Brace for sport. In a trial of 384 athletes, 15% of those given a semi-rigid brace for all sport sprained again within a year, against 27% of those given eight weeks of home training ⁸. A review of 46 reviews rated the evidence for bracing as strong ⁹.
Don't lean on the brace alone. For chronic instability itself, the physiotherapy guideline advises against a brace or tape as the only treatment for balance, and recommends balance and muscle-control exercise ³.
Warm up, in the right shoes. Standard sprain-prevention advice is a warm-up with stretching, strengthening and balance exercises, and supportive shoes suited to the activity ¹.

When to get it checked properly

Book an assessment rather than managing it on your own if:

Your ankle has given way more than once, or often feels like it's about to ²
You've sprained the same ankle again, or keep having near-misses ²
Pain, swelling or weakness is still there long after the original injury ²
You're heading back to sport with sidestepping, jumping or uneven ground and nobody has tested the ankle yet
You've just rolled it again and it's badly swollen or hard to walk on. Treat that as a fresh injury first; our ankle sprain page covers what to do

None of this means something serious is going on. It usually means the ankle hasn't finished its rehab, and that's the part we can work on with you.

Your first appointment

We start by listening: how it began, what makes it worse, and what it's stopping you from doing. Then we examine the area, explain what we find in plain English, and agree a plan with you. Your first visit is 40 minutes at Engadine and 30 minutes at our other clinics.

We see patients at Engadine, Mount Annan, Narellan and Appin, and at home through our mobile physiotherapy service. If you have private health cover, here's how health fund rebates work for physiotherapy.

FAQs

How do you fix chronic ankle instability?

Mostly with exercise. A physio-led program of balance, strengthening and functional exercises is the standard approach ¹, and trials show it improves balance and self-rated function, although the evidence is still very low certainty ⁵. Bracing or taping can add support ^1,6. If rehab doesn't settle clear mechanical looseness, surgery is an option to discuss with a surgeon ⁴.

Is chronic ankle instability permanent?

Not necessarily. "Chronic" describes symptoms that have lasted beyond about 12 months ². It tells you how long it's been going on, not how long it has to last. Exercise programs improve balance and function for many people ⁵. We won't promise a cure, but "permanent" is the wrong place to start.

How long does ankle instability take to heal?

There's no reliable single timeframe. It depends on whether the instability is mainly functional or mechanical ⁴, what you need the ankle to do, and how consistently the program gets done. After an assessment we can give you a realistic estimate for your ankle, not a number from a website.

What are two danger signs for ankle ligament instability?

Repeated sprains, and the ankle giving way or feeling like it's about to ². Either one is a good reason to have it assessed.

What happens if you ignore chronic ankle instability?

The defining symptoms tend to hang around: ongoing pain, swelling, weakness and reduced function, along with more sprains ². That's why we'd rather work on it now than wait for the next roll.

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