/ CONDITIONS / CHRONIC ANKLE INSTABILITY
Chronic Ankle Instability
A persistently unstable ankle that gives way, rolls easily, and re-sprains repeatedly — the long-term consequence of inadequately treated ankle sprains. Conservative and surgical stabilization options available.
Andrew Gunter, DPM — San Antonio, TX.
Call (210) 581-9800
What Is Chronic Ankle Instability?
Chronic ankle instability is the long-term consequence of one or more lateral ankle sprains that were not fully rehabilitated. When the lateral ligaments — most commonly the anterior talofibular ligament and calcaneofibular ligament — are stretched or torn in a sprain, they must be allowed to heal with adequate tension and proper tissue organization. When this healing is incomplete, the ligaments remain permanently lax — stretched beyond their functional length — and the ankle lacks the structural support it needs for normal activity on varied terrain.
The result is an ankle that feels loose, gives way unexpectedly on uneven ground, and re-sprains with progressively less provocation. Each subsequent sprain causes additional ligament damage, cartilage microtrauma from the repeated abnormal joint motion, and increasing mechanical instability. Many patients with chronic ankle instability have had so many sprains they consider it normal for their ankle to roll — it is not. It is a mechanical problem that requires mechanical evaluation and treatment.
Chronic ankle instability is distinct from the acute ankle sprain that may have initiated it. Acute sprains involve tissue damage, inflammation, and healing — the appropriate treatment is rehabilitation during the healing window. Chronic instability involves permanent structural laxity — the tissue has healed in an elongated position. Rehabilitation can strengthen the dynamic stabilizers (peroneal muscles and proprioceptive mechanisms) and provide meaningful functional improvement, but it cannot shorten permanently elongated ligaments. When rehabilitation alone is insufficient, surgical ligament reconstruction restores the structural stability that the chronically lax ligaments cannot provide.
Dr. Gunter evaluates chronic ankle instability clinically — assessing the degree of laxity, proprioceptive function, peroneal strength, and associated findings — and develops a treatment plan that addresses both the dynamic and structural components of instability.
COMMON SYMPTOMS
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Ankle that repeatedly gives way or rolls
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A persistent feeling of looseness in the ankle
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Recurrent sprains with minimal provocation
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Loss of confidence on uneven surfaces or stairs
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Aching or swelling after activity
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The sense that you cannot trust the ankle
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Gradual worsening over months or years of repeated sprains
HOW CHRONIC INSTABILITY DEVELOPS:
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One or more ankle sprains that were not fully rehabilitated
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Lateral ligaments healed in an elongated position
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Stretched ligaments cannot provide structural stability
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Peroneal muscles compensate — but compensation has limits
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Each subsequent sprain adds cumulative ligament damage
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Cartilage in the ankle joint sustains ongoing microtrauma
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Risk of ankle arthritis increases with prolonged instability
Treatment Options for Chronic Ankle Instability
Treatment depends on the degree of ligament laxity, the adequacy of the dynamic stabilizers, and the patient's functional limitations. Dr. Gunter begins with conservative management and discusses surgical stabilization when instability persists despite comprehensive conservative care.
Rehabilitation & dynamic stabilization
Targeted peroneal strengthening, proprioceptive retraining, and neuromuscular rehabilitation improve the dynamic stability of the ankle — the muscle-driven component that partially compensates for ligament laxity. For patients with mild to moderate instability, rehabilitation is the appropriate first step and provides meaningful functional improvement.
Custom orthotics
For patients with underlying foot mechanics — cavus foot, hindfoot varus — that contribute to recurrent lateral ankle loading, custom orthotics addressing these mechanical contributors reduce the frequency of instability episodes alongside rehabilitation.
Ankle bracing
Functional bracing provides mechanical support during high-risk activities — running, trail walking, sports — while rehabilitation addresses the dynamic stability deficit. Bracing does not replace rehabilitation but is an appropriate adjunct during the recovery phase and for patients who cannot tolerate surgical reconstruction.
Surgical ligament reconstruction
For confirmed chronic ligament laxity with persistent functional instability despite comprehensive conservative management, lateral ankle ligament reconstruction restores structural stability. Dr. Gunter performs ligament reconstruction with InternalBrace and its variations at CHRISTUS Santa Rosa Alamo Heights. The procedure tightens, reattaches, and reinforces the chronically lax lateral ligaments to restore their functional tension.
Related conditions: Ankle sprains & instability · Peroneal tendinitis · Ankle fractures · Custom orthotics
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Frequently Asked Questions — Chronic Ankle Instability
Ankle that keeps giving way?
Chronic instability is a mechanical problem with a mechanical solution.
Dr. Andrew Gunter, DPM evaluates chronic ankle instability thoroughly — assessing ligament laxity, dynamic stabilizers, and functional limitations — and recommends the most appropriate treatment from rehabilitation to surgical reconstruction. Serving San Antonio and surrounding communities. Same-day appointments available. Most insurance plans accepted.
Call (210) 581-9800