What is lateral ankle instability?
Lateral ankle instability is a chronic weakness or looseness on the outside of the ankle that causes it to repeatedly roll, give way, or "turn" — often with minimal provocation, such as walking on uneven ground or stepping off a curb. It typically develops after one or more ankle sprains that stretched or tore the ligaments on the outer ankle without fully healing back to their original strength and stability.
The outer ankle is stabilized by a group of ligaments, most importantly the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL). When these ligaments are repeatedly injured, they can heal in a lengthened or lax state, leaving the ankle joint less stable than before. Over time, this can lead to a cycle of repeated sprains, each one further weakening the ankle. If your ankle pain has a different pattern, our ankle fractures page may be a more relevant comparison.
What are the symptoms of lateral ankle instability?
The hallmark symptom is a subjective feeling that the ankle is unreliable — it may "give way" during normal walking, especially on uneven surfaces, stairs, or when wearing heels. Other common signs include:
- Repeated ankle sprains, sometimes from minor missteps
- A sensation of the ankle "giving way" or feeling wobbly
- Chronic swelling or tenderness on the outside of the ankle
- Pain with activity, particularly on uneven ground
- Stiffness or a reduced range of motion after repeated sprains
- Difficulty with balance or a feeling of weakness in the ankle
What causes lateral ankle instability, and who is at risk?
Lateral ankle instability most often develops after one or more significant ankle sprains, particularly if the ligaments were not given adequate time or rehabilitation to heal fully before returning to activity. Contributing factors include:
- A history of repeated ankle sprains on the same side
- Inadequate rehabilitation or bracing after a prior sprain
- Naturally lax ligaments or joint hypermobility
- Participation in sports involving cutting, jumping, or uneven terrain
- Weakness in the muscles that support and stabilize the ankle
- Poor proprioception, or reduced sense of joint position
Athletes in sports like basketball, soccer, and trail running are at particular risk because of the repetitive lateral movement and uneven surfaces involved.
How do we diagnose lateral ankle instability?
Diagnosis starts with a detailed history of your prior sprains and current symptoms, followed by a hands-on examination that tests the ankle's stability and range of motion, checking specifically for excess laxity in the ligaments on the outside of the ankle. Your podiatrist will also assess your gait and balance.
Imaging such as X-rays helps rule out a fracture or other bony injury, while an MRI may be used in some cases to evaluate the ligaments directly and check for other associated injuries, such as cartilage damage in the joint. Stress imaging can also help confirm the degree of instability present.
How is lateral ankle instability treated?
Most cases of lateral ankle instability improve with a structured nonsurgical program, so we typically start conservatively and reserve surgery for ankles that remain unstable despite dedicated rehabilitation.
Nonsurgical treatment
- Physical therapy focused on strengthening the muscles around the ankle and improving balance and proprioception
- Ankle bracing to provide external support during activity
- Activity modification to reduce further injury while healing
- Custom orthotics to improve foot alignment and reduce strain on the ankle — see our custom orthotics options
- NSAIDs to manage pain and inflammation during flare-ups
Surgery
When the ankle remains unstable after a genuine course of physical therapy and bracing, surgical ligament repair or reconstruction may be recommended. This typically involves tightening or reconstructing the stretched lateral ligaments to restore normal ankle stability. Our physicians will discuss whether a repair, reconstruction, or an alternative technique such as the Dual Syndesmosis TightRope is appropriate for your specific injury pattern.
What is recovery from lateral ankle instability like?
Recovery with nonsurgical treatment centers on consistent physical therapy — strengthening and balance work usually unfold over several weeks to a few months, and staying with the program even after symptoms improve is key to preventing future sprains. If surgery is needed, most patients are placed in a protective boot or cast for a period of weeks, followed by a structured rehabilitation program to gradually restore strength, motion, and balance before returning to full activity.
When should you see a podiatrist for ankle instability?
See a podiatrist if your ankle has sprained more than once, if it regularly feels like it's going to give way, or if you have ongoing swelling, pain, or weakness after a sprain that hasn't fully resolved. Early evaluation and proper rehabilitation after even a single significant sprain can help prevent the instability cycle from developing in the first place. When you're ready, you can request an appointment at either of our Northern Utah offices.
Why choose Wasatch Foot & Ankle Institute?
Wasatch Foot & Ankle Institute is a locally rooted podiatry practice serving Farmington, South Ogden, and the surrounding Davis and Weber County communities. Our board-certified, fellowship-trained physicians treat ankle instability at every stage, from first-time sprains and structured rehabilitation to advanced ligament reconstruction for ankles that need surgical stabilization.
We treat patients from both of our clinics; learn more about our Farmington and South Ogden locations or call the office nearest you.
Medically reviewed by the physicians at Wasatch Foot & Ankle Institute. Our board-certified, fellowship-trained podiatrists provide foot and ankle care in Farmington and South Ogden, Utah. This page is for general education and is not a substitute for an in-person evaluation.