You twist your ankle, feel the sharp pain and assume it is just a sprain that will settle with time. For many people, that is exactly what happens. But for others, the ankle never quite feels the same again.
Weeks or even months later, there may be a lingering sense that the ankle is unreliable. It may “give way” unexpectedly, feel unstable on uneven ground or limit confidence during activity. While these symptoms are often dismissed as part of recovery, they can sometimes point to a deeper issue.
Understanding when a sprained ankle has progressed beyond a simple injury is important. In some cases, persistent instability may indicate that the supporting ligaments have not healed adequately and may require more than physiotherapy alone.
What Happens in an Ankle Sprain?
An ankle sprain occurs when the ligaments that support the joint are stretched or torn, usually from a sudden twist or roll of the foot. These ligaments play an important role in keeping the foot and ankle stable, especially during movements such as walking on uneven surfaces or changing direction.
Sprains are commonly classified by severity:
Mild: slight stretching of the ligaments with minimal swelling
Moderate: partial tearing with more noticeable pain, swelling, and some instability
Severe: complete tear with significant pain, swelling, and difficulty bearing weight
In many cases, ankle sprains heal well with rest, rehabilitation and a gradual return to activity. Physiotherapy helps restore strength, balance and coordination, allowing the ankle to function normally again.
However, not all sprains recover in the same way. In some individuals, the ligaments may not heal fully, which can affect the stability of the ankle over time.
When Does a Sprained Ankle Become Mechanically Unstable?
Most ankle sprains improve with rehabilitation, but in some cases, the ligaments do not fully regain their strength. When this happens, the ankle may lose its ability to stay stable during movement, resulting in mechanical instability. It is important to distinguish this from functional instability.
Functional instability
The ankle feels weak or unsteady, often due to reduced strength, balance or coordination. This typically improves with physiotherapy and strengthening.
Mechanical instability
The ligaments are stretched or lax, meaning the ankle lacks structural support. This can lead to repeated “giving way” and may persist despite proper rehabilitation.
Symptoms that may indicate mechanical instability include:
Poor balance that does not improve with rehabilitation
How Mechanical Instability Is Diagnosed
Diagnosing mechanical ankle instability involves a combination of clinical assessment and imaging (when needed). A detailed history is important, particularly if there have been repeated sprains, ongoing instability or symptoms that have not improved with physiotherapy.
During a physical examination, specific tests are performed to assess ligament integrity and ankle stability. These help determine whether the looseness is due to muscular weakness or true ligament laxity.
If further clarification is needed, imaging may be recommended. Stress X-rays can evaluate how much the joint moves under load, while MRI can assess the condition of the ligaments and identify any associated injuries such as cartilage damage.
When Is Surgical Stabilisation Considered?
Surgical stabilisation is typically considered when symptoms persist despite appropriate non-surgical treatment. This often includes a structured course of physiotherapy, activity modification and, in some cases, bracing. If the ankle continues to feel unstable or repeatedly gives way, it may indicate that the ligaments are not able to provide sufficient support.
Surgery may be recommended in the following situations:
Ongoing instability that affects daily activities or sports
Symptoms that limit confidence in movement or performance
Evidence of ligament laxity on clinical assessment or imaging
Associated issues such as cartilage damage or chronic pain
The goal of surgical stabilisation is to restore the structural support of the ankle by repairing or reconstructing the damaged ligaments. This helps improve stability, reduce the risk of further injury and support a safer return to activity.
What Does Surgical Stabilisation Involve?
Surgical stabilisation aims to restore the ankle’s structural support by repairing or reconstructing the damaged ligaments. The goal is to improve stability, reduce recurrent sprains and support a safer return to activity.
The most common procedure is the Broström repair, which tightens and repairs the ligaments on the outer side of the ankle. If the ligaments are too damaged for repair, a ligament reconstruction using a tendon graft may be required instead.
In some cases, arthroscopy may also be performed to assess and treat associated problems within the joint, such as cartilage injuries.
After surgery, rehabilitation is important to restore strength, balance and mobility. With proper recovery and physiotherapy, many patients are able to return to their usual activities with improved ankle stability.
Restoring Stability After an Ankle Sprain
While many ankle sprains heal well with rehabilitation, persistent instability should not be ignored, especially if the ankle continues to give way or feel unreliable during activity. Early assessment and appropriate treatment can help restore stability, reduce the risk of further injury and support a safer return to daily activities and sports.
Axis Orthopaedic Centre is an orthopaedic clinic in Singapore committed to helping patients recover confidently from foot and ankle injuries, and return to their daily activities with improved stability and function. Led by Dr Seng Chusheng, the team has extensive experience in managing both acute and chronic ankle conditions, including recurrent ankle instability requiring surgical stabilisation. If you continue to experience repeated ankle sprains, instability, or persistent discomfort after an ankle injury, schedule a consultation with us to undergo a thorough evaluation and discuss personalised treatment options tailored to your recovery goals.
FAQs About Surgical Stabilisation for Sprained Ankles
Can chronic ankle instability occur after just one sprain?
Yes. While repeated sprains increase the risk, some individuals may develop persistent instability even after a single severe ankle injury.
Can both ankles become unstable?
Yes. Individuals who are prone to ankle sprains or participate in high-risk sports may develop instability in either or both ankles over time.
Is ankle stabilisation surgery considered major surgery?
Ankle stabilisation is generally considered a routine orthopaedic procedure, although recovery and rehabilitation are still important for achieving the best outcome.
Dr Seng Chusheng is a consultant orthopaedic surgeon with a clinical focus on foot and ankle surgery as well as knee surgery. He obtained his MBBS and Master of Medicine in Orthopaedic Surgery from the National University of Singapore and is a Fellow of the Royal College of Surgeons of Edinburgh.
He completed advanced training at the Assal Centre in Geneva, Switzerland, with emphasis on complex foot and ankle deformities, trauma and minimally invasive techniques. Prior to private practice, Dr Seng served as a consultant orthopaedic surgeon at Singapore General Hospital and continues to practise there as a visiting consultant. He is also involved in orthopaedic research, with publications in peer-reviewed journals and has received the Japanese Orthopaedic Association Travelling Fellowship.
