Your ankle joint allows your foot to move up and down. This action is called dorsiflexion (toes closer to the shin) and plantar flexion (foot pointing down). It shouldn’t move from side to side.
When things are working properly, the side-to-side motion in your foot comes from three different joints in the foot that aren’t part of the ankle.
But when you experience ankle instability, your ankle moves abnormally in the ankle joint, often because the ligaments have become weak or damaged and can no longer keep the ankle joint stable.
It’s a familiar feeling: You roll your ankle when attempting to change direction quickly, stepping off a sidewalk, or when walking on uneven ground.
An unstable ankle will be susceptible to rolling or giving way, potentially damaging cartilage in the joint or damaging tendons, causing short- or long-term pain.
What Is Ankle Instability?
Ankle instability occurs when the ligaments that hold the ankle stable become weak or even torn. This makes keeping the joint properly aligned difficult, leading to frequent episodes of the ankle feeling weak or painful.
Instability can cause significant discomfort. It may accompany chronic swelling or pain, especially if an old injury has never completely healed.
Ankle instability is common among athletes, particularly those with multiple ankle sprains. But it doesn’t only affect athletes. Anyone with a history of ankle sprains can have ankle instability, regardless of their activity level.
Why Do Ankles Give Out?
Ankle instability happens because of repeated ankle sprains. It often starts with an initial sprain. A severe sprain can leave the ligament strained and weaker even after healing. Stretched ligaments cause unwanted motion of the ankle joint, which can increase your risk of repeated injury or early onset arthritis.
Up to 70% of individuals who sustain an acute, incidental lateral ankle sprain may develop chronic ankle instability shortly after the initial injury. Up to 40% of patients with first-time ankle sprains had chronic ankle instability at a 12-month follow-up. This is according to research in the Journal of Athletic Training.
A study in the Avicenna Journal of Medicine found that about 20% of acute ankle sprain patients also developed chronic ankle instability.
Ankle instability can result in swelling and pain. But other times, you may feel unsteady during activity. Balancing on the affected foot may also pose a challenge.
Symptoms of Ankle Instability
Ankle instability often presents in different ways. It can range from mild discomfort to significant pain and functional impairment.
Common symptoms include:
- Frequent rolling of the ankle — One of the clearest signs of ankle instability is frequent rolling or twisting. This is especially true during simple activities such as walking on uneven ground or stepping off a curb.
- Reduced range of motion — Due to ligament damage and swelling, the ankle may feel stiff or have a reduced range of motion. This can limit activities that require flexibility, such as squatting or walking up and down stairs.
- Swelling and pain — Swelling in the ankle area may recur, particularly after physical activity.
- Unsteady feeling — Some people describe feeling wobbly as if their ankles cannot hold them up or that their ankles are weak. This can make balance, particularly on one foot, challenging.
Why Do Old Injuries Cause Ankle Swelling?
Swelling from an old ankle injury that persists or recurs may indicate underlying instability. Ligament or cartilage damage from previous injuries can make the ankle swell due to inflammation with increased activity and stress on the joint.
An old, unhealed injury can make the ankle more susceptible to swelling and pain. This may significantly limit your physical activity.
Old injuries can leave scar tissue in the joint, which may have less flexibility or strength than the original ligament tissue. Scar tissue can cause restricted movement, swelling, and pain during activities that stress the ankle. Without proper treatment, the likelihood of reinjury increases, perpetuating a cycle of instability.
How to Treat Ankle Instability
You don’t need to have a major injury to seek treatment. If you feel your ankle is unstable or tends to give way, a doctor can help you regain ankle stability. Seeking treatment can help reduce the risk of repeat injury or damage.
The doctor will examine your ankle and discuss treatment options with you to aid in finding relief.
See a doctor for old or new injuries that cause pain, swelling, and difficulty walking. They will likely suggest rest, ice, compression, and elevation (RICE) as a first-line treatment. They may also order imaging, such as an x-ray to rule out other underlying issues or an MRI to examine the tendons, ligaments, and cartilage.
Orthotics for ankle instability
Depending on your diagnosis, an ankle brace, walking boot, or another orthotic device may benefit and help stabilize the ankle, allowing the soft tissues to heal. Anti-inflammatory medicine can help with pain and swelling.
Physical therapy for ankle instability
Physical therapy and coordination exercises can help with an unstable ankle. It can assist with regaining strength to reduce instability. Exercise and balance training can help prevent further injury.
Surgery for ankle instability
Some people may ultimately need surgical repair if the ligaments are severely damaged or if their symptoms do not respond to conservative treatments. Ankle ligament reconstruction surgery can restore stability in the ankle.
Never hesitate to see a doctor if you have had an ankle injury and experience weakness, pain, or instability. It’s always better to treat ankle instability early on to prevent long-term pain and lower the risk of recurrent injury.
Learn more about ankle instability and how UPMC Orthopaedic Care can help.
Editor's Note: This article was originally published on , and was last reviewed on .