What helps against chronic ankle instability?

There are various treatment options for chronic ankle instability: Conservative treatment is tried first. This involves doing physical therapy (physiotherapy) to strengthen the joint, and possibly wearing an ankle brace or splint to stabilize it.

One common physical therapy approach is called neuromuscular training. It aims to improve the ankle's strength, stability and coordination. Research has shown that neuromuscular training can actually improve the stability and the movement of the ankle in the first few weeks. But there isn't enough research on the long-term effectiveness of this treatment.

If the joint remains unstable despite this training because the ligaments are too loose, surgery may be considered. One option is to shorten and tighten the ankle ligaments. Another option is to take a tendon out of the lower leg and use it as an outer ligament on the ankle. Tendons and ligaments are made from similar tissue.

Ankle instability often leads to problems with muscle coordination. For this reason, exercises are always an important part of rehabilitation after surgery. It also helps to wear an ankle brace or splint during this time, to give the ankle external support. The pressure it puts on the joint can help you to regain a good sense of muscle coordination too.

People probably benefit from starting movement, strength and coordination exercises two to three weeks after surgery at the latest. Studies suggest that people who do this become active again sooner than those keep their foot still for six weeks and don't do any exercises during that time. The study participants who had started doing exercises and strength training earlier were able to go back to work about one to two weeks sooner. They were also able to do sports again about three weeks sooner. But no advantages could be seen anymore after about two years: The stability and flexibility of participants' ankle joints were the same in both groups. Many of these studies had few participants, though, or were poorly done. This means that their results need to be interpreted with caution.

There were no studies comparing surgery directly with physical therapy or other treatments. For this reason, it's not possible to say who would benefit most from surgery, or how effective it is compared with non-surgical (conservative) treatment.

It is also not clear how the various surgical procedures compare with one another. There are only few small studies on this, and they don't provide reliable results. One study looked at a surgical procedure called “Chrisman Snook,” in which the ligaments are strengthened using tendons taken from the foot or the lower leg. Compared to other procedures, it resulted in more complications, including nerve damage.

Overall, it's currently not clear whether surgery leads to a faster recovery than strength and coordination training does. But if the ankle remains unstable because of loose ligaments, surgery might be an option. Regardless of which treatment you choose: With a little patience, sprained ankles usually become stable again.