The 2016 consensus statement describes many patients developing physical and subjective functional limitations, with ongoing “giving-way” in the affected ankle, resulting in the defined condition of chronic ankle instability [2]. AAOS OrthoInfo says incomplete rehabilitation is the most common cause of chronic ankle instability after a sprain [1].
AAOS OrthoInfo says that once you have sprained your ankle, you may continue to sprain it if the ligaments do not have time to completely heal [1].
This page is about what happens after a sprain. For general prevention, see Preventing common ankle injuries.
- Why do some ankles keep getting injured?
- What is chronic ankle instability?
- Can an old ankle injury be linked to arthritis?
- How do rehabilitation, balance and supports fit in?
- When should an ankle that keeps giving way be assessed?
- When is urgent help needed?
- What should I do next?
Why do some ankles keep getting injured?
AAOS OrthoInfo says a previous ankle sprain increases the risk of a repeat sprain [1].
AAOS OrthoInfo says this can happen if you return to work, sports, or other activities before your ankle heals and is rehabilitated [1].
AAOS OrthoInfo says that without proper treatment and rehabilitation, a chronic or untreated severe sprain can weaken your ankle, making it more likely that you will injure it again [1].
What does the 2016 consensus statement say?
A 2016 consensus statement of the International Ankle Consortium says the majority of patients with a history of lateral ankle sprain will sustain at least one additional sprain [2]. A lateral ankle sprain involves the ligaments on the outer side of the ankle [1].
The statement is a 2016 position paper of the consortium’s Executive Committee, with recommendations drawn from a companion evidence review [2].
Owner clinical review required · not a release assetWhat is chronic ankle instability?
The 2016 consensus statement describes many patients developing physical and subjective functional limitations, with ongoing “giving-way” in the affected ankle, resulting in the defined condition of chronic ankle instability [2].
AAOS OrthoInfo lists instability of the ankle, or a feeling that your ankle is giving out, among the symptoms [1].
AAOS OrthoInfo uses a separate term, “chronic ankle sprain”, and says that if pain continues for more than 4 to 6 weeks, you may have one [1].
AAOS OrthoInfo says incomplete rehabilitation is the most common cause of chronic ankle instability after a sprain [1].
AAOS OrthoInfo says repeated ankle sprains can lead to long-term problems, including chronic ankle pain, arthritis, and instability [1].
Can an old ankle injury be linked to arthritis?
The 2016 consensus statement says patients with a history of lateral ankle sprain and chronic ankle instability dominate the cases of ankle arthritis that follow an injury, and that these make up the majority of ankle arthritis surgery cases [2].
This describes people who had ankle arthritis surgery. It does not show that every sprain leads to arthritis. The statement says the timing of arthritis after a sprain still needs research [2].
What does the statement say about timing?
The statement says the onset of this kind of ankle arthritis is happening relatively early in life [2].
How do rehabilitation, balance and supports fit in?
AAOS OrthoInfo includes proprioception (balance) training in rehabilitation, and says poor balance often leads to repeat sprains and ankle instability [1].
The 2016 consensus statement says clinicians and researchers should encourage proper follow-up with a standard of rehabilitation, while simultaneously allowing for optimal tissue restoration [2].
For general ways to lower the chance of an ankle injury, see Preventing common ankle injuries.
What does the evidence say about braces and ankle disk training?
A 2001 Cochrane review of interventions for preventing ankle ligament injuries, with content assessed as up-to-date on 30 October 2000, is the source here [3]. The review’s most recent search was in July 2000 [3].
That review says participants with a history of previous sprain can be advised that wearing ankle supports may reduce the risk of incurring a future sprain [3]. The review describes these supports as semi-rigid orthoses or air-cast braces (the review’s plain-language summary calls them semi-rigid braces), studied during high-risk sporting activities such as soccer and basketball [3].
The review adds that any potential preventive effect should be balanced against the baseline risk of the activity, the supply and cost of the particular device, and for some, the possible or perceived loss of performance [3].
The review found limited evidence for reduction in ankle sprain for those with previous ankle sprains who did ankle disk training exercises (co-ordination exercises on an ankle disk) [3].
When should an ankle that keeps giving way be assessed?
The 2016 consensus statement says lateral ankle sprain is a noteworthy injury that warrants treatment by a trained healthcare professional [2].
AAOS OrthoInfo says you may need to be seen by a medical professional to make sure you do not have a severe sprain or fracture if your ankle remains swollen or painful for several weeks despite conservative treatments, or if you have trouble putting weight on your ankle [1].
AAOS OrthoInfo says symptoms of a severe sprain are similar to those of a broken bone and require prompt medical evaluation [1].
When is surgery an option?
AAOS OrthoInfo says surgery is reserved for injuries that do not respond to nonsurgical treatment, and for patients who continue to have ankle instability and pain after months of rehabilitation and nonsurgical treatment [1].
- Read more about ankle sprains.
- Read more about ankle ligament tears.
- Read about telling a fracture from a sprain.
When is urgent help needed?
The list below covers the signs that should not wait for a routine appointment.
What should I do next?
If an ankle keeps giving way, or you are unsure what is causing it, an assessment is a sensible next step. The assessment brings together the patient’s story, an examination and any tests that help, so that the patient and the surgeon can decide together. It looks at the structure involved, the patient as a whole person and the goal they want to return to. An appointment supports an informed decision. It is not a commitment to surgery.
- Read about the Foot and Ankle Hub.
- Read about sports injuries.
This page provides general information and cannot diagnose an individual condition. OrthoKinetics does not provide emergency or urgent care through this webpage or its WhatsApp contact.
References
- AAOS OrthoInfo. Sprained Ankle. https://www.orthoinfo.org/diseases–conditions/sprained-ankle
- Consensus statement of the International Ankle Consortium: prevalence, impact and long-term consequences of lateral ankle sprains. Br J Sports Med. 2016;50(24):1493. https://bjsm.bmj.com/content/50/24/1493
- Handoll et al. Interventions for preventing ankle ligament injuries. Cochrane Database Syst Rev. 2001, CD000018. https://pubmed.ncbi.nlm.nih.gov/11686947/
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