In brief: chronic ankle instability is a laxity of the lateral ligaments that persists after one or more poorly healed sprains. The ankle still gives way, sometimes without pain. It is evaluated in clinic (history, examination, imaging) and managed initially without surgery: proprioception, strengthening, custom orthotics if needed, external support.
You twisted your ankle months, sometimes years, ago. The injury seemed to heal. Yet, your ankle still gives way at the slightest misstep. It turns on a sidewalk, on uneven ground, sometimes during a simple walk. You no longer fully trust it.
What you are experiencing has a name: chronic ankle instability. It is a common consequence of sprains and often goes unnoticed. Many people endure it, thinking there is nothing to be done. This article explains what happens in the joint, why the problem develops, and how it is evaluated and managed at the clinic in Gatineau.
Written by Dr. Émile Carrier, Podiatrist (OPQ 19019), Podiatric Medicine of Plateau, AGORA, Gatineau.
What is Chronic Ankle Instability?
Chronic ankle instability is a residual laxity of the lateral ligaments that develops after one or more poorly healed sprains. Specifically, the joint becomes less stable. It involves two components: mechanical instability, related to ligamentous laxity, and perceived instability, the feeling that the ankle will give out.
It is one of the most common reasons for consultation when it comes to the ankle. The problem does not appear overnight. It develops gradually, often because the initial sprain was downplayed or recovery was cut short.
The distinction between acute and chronic matters. A recent sprain is a fresh injury. Chronic instability, however, is usually recognized at least one year after the initial injury, once the acute phase has passed. And the risk is not anecdotal: up to 40% of people who suffer a first lateral sprain subsequently develop chronic instability (clinical update 2025).
How to Know if Your Ankle is Unstable?
The first sign is repetition. You twist the same ankle again and again, sometimes for trivial reasons. Stepping off a curb, walking on uneven grass, or changing direction is enough to make it give way.
Added to this is the sensation of giving way or buckling, the feeling that the ankle ‘goes out on its own.’ Many people describe a permanent apprehension on uneven terrain. Others notice recurring swelling, brief locking, or stiffness upon waking. Pain, however, is not always present. An ankle can be unstable without continuous pain. If it’s more a persistent ankle pain that brings you in, the picture and the approaches are not quite the same.
When to consult? As soon as sprains recur, your confidence in your ankle diminishes, or you modify your activities to avoid it. Waiting for it to worsen does not make the problem easier to treat.
| What we observe | Recent sprain | Chronic ankle instability |
|---|---|---|
| Timing | Fresh injury, acute phase | Usually at least one year after the initial injury |
| What happens | Lateral ligaments stretched or partially torn | Ligaments less resistant and proprioception disturbed |
| What you feel | Pain, swelling | Ankle giving way, apprehension, recurring swelling, not always pain |
| The trap | Downplaying it | Mistaking ‘no longer having pain’ for ‘being healed’ |
Is Ankle Instability Serious?
It’s not an emergency, but it’s not insignificant either. With repeated microtraumas, the joint wears down. The main long-term risk is post-traumatic osteoarthritis, meaning a progressive degradation of the ankle cartilage. This is accompanied by pain, swelling, and stiffness that develops over the years.
There is also a less visible cost: loss of confidence. We reduce our activities, avoid certain sports, and walk while watching every step. It is precisely to avoid this decline that early intervention makes sense.
Why Does an Ankle Become Unstable After a Sprain?
During a sprain, the ligaments on the outside of the ankle stretch or partially tear. The anterior talofibular ligament is most often affected, followed by the calcaneofibular ligament. If healing occurs under poor conditions, the fibers of these ligaments repair in a disorganized manner. The ligaments then become less resistant and perform their stabilizing role less effectively.
But mechanics don’t explain everything. A sprain also damages proprioception, the sense that allows your brain to know where your foot is in space. When these receptors are disturbed, the ankle reacts too late to imbalances. It gets caught off guard, then it turns.
Older factors often come into play. A varus hindfoot, a cavus foot or a flat foot alter the alignment of the entire leg. This deviation, even slight, adds abnormal stress to the ankle. It’s common: a combination of ligamentous laxity, proprioceptive deficit, and an alignment defect.
Why is Ankle Instability Often Misunderstood?
Ankle instability is often misunderstood, both by people searching on their favorite internet search engine and in the follow-up of many sprains. The cause of the misunderstanding is simple: sprains are trivialized. People believe a twisted ankle heals on its own and that all you have to do is wait.
Another classic confusion: ‘no longer having pain’ is mistaken for ‘being healed.’ However, pain often disappears long before stability and proprioception are recovered. Activities are resumed too soon, on an ankle that is not ready, and then the first relapse occurs.
Finally, several situations resemble instability without being one. An affection of the fibular tendons, early osteoarthritis, or an associated lesion can produce similar sensations. This is why a clear diagnosis precedes any treatment.
How is Chronic Ankle Instability Treated?
It all starts with understanding your ankle’s history. This is where our podiatrists’ skills come into play: they ask the right questions to understand the context of symptom onset, activities practiced, and footwear used. Your podiatrist in Gatineau traces the number of sprains, the circumstances, what triggers the episodes, and what limits you daily. Next comes the examination: mobility, laxity tests, balance assessment, and an evaluation of foot alignment.
At our clinic in AGORA in the Plateau (Hull-Aylmer in Gatineau), radiography and musculoskeletal ultrasound are available on-site. Imaging helps to visualize the condition of the ligaments, identify fibular tendon involvement, or signs of early osteoarthritis.
At the clinic, the evaluation of an unstable ankle follows these steps:
- tracing your ankle’s history: number of sprains, circumstances, what triggers the episodes;
- examining mobility, performing laxity tests, and assessing balance;
- evaluating foot and hindfoot alignment;
- supplementing with on-site radiography or ultrasound if needed;
- establishing a management plan based on what makes your ankle unstable.
There is no single treatment. The plan is established after evaluation, according to what makes your ankle unstable. Combined options often include:
- proprioception work and strengthening of stabilizing muscles, particularly the evertors, to restore the ankle’s reactive capacity;
- custom foot orthotics when a foot alignment defect maintains instability;
- external support, brace or bandage, to secure certain activities during recovery;
- advice on appropriate footwear and, if fibular tendinopathy accompanies the picture, modalities such as shockwave therapy.
Dr. Sandra Gendron, Dr. Stephen Davis, and Dr. Émile Carrier, podiatrists, evaluate and diagnose, then establish the plan. Understanding how it appeared is our job. When conservative treatment is insufficient, ligament reconstruction surgery may be considered. This intervention is performed in a surgical setting, by referral, in rare cases of conservative approach failure.
What Exercises Strengthen an Unstable Ankle?
Two axes always recur: proprioception and strengthening. Balance work retrains the ankle to correct its imbalances, first on a stable surface, then on more demanding supports. Strengthening primarily targets the muscles that control outward foot movement.
Two conditions are as important as the exercises themselves: regularity and progression. Sessions done once in a while change little. And these exercises benefit from being adapted to your ankle rather than copied from a generic video, because a poorly targeted deficit is difficult to correct.
Can Ankle Instability Disappear?
In many people, well-conducted conservative management significantly improves stability and reduces recurrences. However, results vary from one ankle to another, depending on the extent of laxity, the duration of the problem, and associated factors. If instability persists despite serious rehabilitation, surgical intervention remains an option to discuss. The important thing is not to let time decide for you.
When to Consult a Podiatrist for an Unstable Ankle?
The right time is when sprains recur or when you start avoiding everyday activities. The earlier instability is addressed, the more we limit the risk of long-term joint wear. There’s no need to wait for another sprain to act.
An ankle that still gives way needs evaluation. We look at what made it unstable, then establish a plan adapted to your situation. We can often see you quickly.
Frequently Asked Questions about Chronic Ankle Instability
How do you know if you have ankle instability?
Recurring sprains, a sensation that the ankle gives way, apprehension on uneven terrain, and recurring swelling or locking are typical signs. An examination confirms the diagnosis.
Can ankle instability disappear?
Well-conducted conservative management often improves stability and reduces recurrences. Results vary for each ankle. In case of failure, a surgical option can be discussed.
Is ankle instability serious?
It’s not an emergency, but if left untreated, it wears down the joint and can lead to post-traumatic osteoarthritis. Early evaluation limits this risk.
Which professional to consult for an unstable ankle?
A podiatrist evaluates, diagnoses, then establishes a plan (proprioception, custom orthotics, external support), with on-site radiography and ultrasound. Surgery is done by referral if necessary.
To learn more
- Persistent Ankle Pain: Podiatric Solutions in Gatineau
- Custom Foot Orthotics in Gatineau
- Ultrasound of the feet and ankles
Book an appointment: podiatreplateau.com/nous-joindre/
819 800-1212 | AGORA, Gatineau
Results vary according to the condition of each person.
About the author: Dr. Émile Carrier, Podiatrist
Member of the Ordre des podiatres du Québec (OPQ 19019), graduated from UQTR. He practices at Podiatric Medicine of Plateau, at AGORA in Gatineau.
Published September 16, 2026. Updated September 2026.
