Common Causes of Ankle Instability and How to Treat Them

Ankle instability is a condition where the ankle feels weak, wobbly, or prone to giving way—particularly during walking, running, or uneven ground navigation. It often develops after repeated ankle sprains or injuries that have not healed properly. Over time, instability can increase the risk of further sprains, limit activity, and cause joint degeneration.

Understanding the root causes of ankle instability is essential for effective treatment and prevention. With proper management, most individuals can regain control, confidence, and strength in their ankle joints.

Chronic Ligament Laxity from Repeated Sprains

One of the most common causes of ankle instability is damage to the lateral ligaments—especially the anterior talofibular ligament (ATFL). When sprains occur repeatedly without full recovery, the ligaments become stretched and weakened.

Typical symptoms include:

• Rolling of the ankle even on flat surfaces

• Sensation of looseness or instability

• Pain and swelling after activity

What to do:
Engage in proprioceptive and strengthening exercises targeting the ankle and surrounding muscles. Bracing may help during high-risk activities. Severe cases may require surgical ligament repair.

Peroneal Muscle Weakness or Dysfunction

The peroneal muscles, which run along the outside of the lower leg, play a crucial role in ankle stability. Weakness or delayed activation can result in poor control during lateral movements, increasing the risk of instability.

Signs of involvement:

• Difficulty balancing on one leg

• Ankle rolling during pivoting or turning

• Mild aching along the outer shin

What to do:
Rehabilitation should focus on eccentric strengthening and neuromuscular control. Balance boards, resistance bands, and EMS may support retraining the peroneals.

Joint Hypermobility or Laxity

Some individuals are naturally hypermobile, meaning their ligaments allow excessive joint movement. While this can be advantageous in activities like dance or gymnastics, it also predisposes the ankle to instability.

Key characteristics include:

• Frequent sprains with minimal trauma

• Hyperextension in other joints (e.g. elbows, knees)

• Pain or clicking during motion

What to do:
Build muscular support around the joint through core and ankle stabilisation. Avoid hypermobile positions and consider footwear with structural support. Severe or symptomatic cases may benefit from regenerative therapies.

Poor Proprioception or Balance

After an ankle injury, the nerve receptors responsible for sensing joint position can become less responsive. This leads to impaired feedback and control during movement, increasing the likelihood of ankle roll or misstep.

Common indicators:

• Trouble navigating uneven ground

• Feeling “unsure” of foot placement

• Slow reaction to changes in surface or direction

What to do:
Use dynamic exercises that challenge balance, such as single-leg stands, wobble boards, or MAI-Motion™ gait analysis to retrain joint coordination.

Untreated or Mismanaged Ankle Sprains

Many people underestimate ankle sprains and return to sport or activity too soon. Without proper rehabilitation, the ligaments and muscles don’t fully recover, laying the groundwork for chronic instability.

Warning signs include:

• Ongoing swelling or pain weeks after injury

• Difficulty regaining full range of motion

• Recurrent rolling or shifting sensations

What to do:
Seek medical evaluation and follow a guided rehab plan. Persistent instability may require imaging (MRI or onMRI™) to assess ligament integrity or joint damage.

Treating and Preventing Ankle Instability

The foundation of treatment lies in restoring strength, stability, and proprioception. Ignoring instability increases the risk of long-term complications such as arthritis, cartilage damage, or tendon issues.

Treatment approaches may include:

• Physiotherapy – for guided muscle strengthening and control

• Bracing or taping – during high-risk activities

• Regenerative injections – such as PRP or hyaluronic acid for chronic ligament damage

• Surgical repair – in cases where conservative methods fail

• Motion tracking – using MAI-Motion™ to detect asymmetries or compensation patterns

Early intervention provides the best outcomes, especially in athletes or individuals who rely on joint agility and performance.

Frequently Asked Questions (FAQs)

How do I know if I have ankle instability?
If your ankle frequently gives way or you feel unsure on uneven surfaces, you may have instability. A clinical exam and movement analysis can confirm the diagnosis.

Is surgery always needed for ankle instability?
No—many cases improve with structured physiotherapy and supportive devices. Surgery is reserved for cases with confirmed ligament rupture or chronic instability unresponsive to rehab.

Can ankle instability lead to arthritis?
Yes, if left untreated, instability can cause abnormal joint mechanics, accelerating cartilage wear and contributing to early osteoarthritis.

What exercises help ankle stability?
Balance exercises, resistance band strengthening, and proprioception drills are key. Exercises should progress as control improves.

Should I wear an ankle brace every day?
Continuous use is not advised long term. Bracing should be used strategically during high-risk activities while focusing on restoring natural joint stability through rehab.

Can regenerative medicine help ankle instability?
Yes. PRP, prolotherapy, or stem cell injections may help stimulate repair in ligaments with chronic damage. These are especially useful when combined with physiotherapy.