Giving way means the ankle suddenly feels unable to support you, often during walking, running, changing direction or stepping on uneven ground.

Some patients describe a brief wobble; others experience a complete roll followed by pain or swelling. Repeated episodes after an ankle sprain are commonly described as chronic ankle instability.

The problem may be mechanical, because damaged ligaments have become loose, functional, because balance and neuromuscular control have not recovered, or a combination of both.

Patients typically say they don’t trust their ankle or they have to watch every step.

Previous ankle sprains are the leading cause, but recurrent giving-way is not always simply a “weak ankle”.

• Stretched or torn lateral ligaments, particularly the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL).
• Reduced proprioception: the ankle reacts too slowly when the foot starts to turn.
• Weakness or delayed activation of the peroneal muscles on the outside of the ankle.
• Peroneal tendon tears or tendon subluxation.
• Cartilage or osteochondral injury inside the ankle, especially when there is deep pain, swelling, catching or locking.
• Syndesmosis injury (high ankle sprain), which may cause pain above the ankle and difficulty with twisting or push-off.
• Foot shape, generalised ligament laxity or previous fracture.

Related information: ankle ligament repair (Broström) · high ankle sprains and syndesmosis injuries · peroneal tendon disorders

Arrange an assessment when giving-way is recurrent, persists despite rehabilitation, or is accompanied by pain, swelling, locking or loss of function.

Seek earlier advice after a major injury, if you cannot bear weight, if the ankle looks deformed, or if there is numbness or progressive weakness. Persistent symptoms are important because recurrent instability can expose the joint to repeated injury and may coexist with cartilage damage.

A careful examination should assess ligament stability, tendon function, foot alignment, balance and the location of pain rather than relying on an MRI report alone.

Diagnosis usually begins with the history and physical examination; imaging is selected to answer a specific clinical question.

Weight-bearing X-rays assess alignment, previous injury and arthritis. MRI can show ligament, tendon and cartilage pathology. Ultrasound can dynamically assess the peroneal tendons. Weight-bearing CT may be useful when subtle alignment, joint loading or syndesmotic instability is suspected.

Not every abnormality on a scan causes symptoms, so imaging should be interpreted alongside the examination.

Structured rehabilitation is the first treatment for most people with chronic ankle instability.

• Balance and proprioception exercises.
• Peroneal, calf and whole-leg strengthening.
• Range-of-motion work, particularly restoring ankle dorsiflexion.
• Sport-specific landing, hopping and change-of-direction training.
• A brace or taping for higher-risk activities while control improves.

Clinical practice guidelines support exercise-based rehabilitation and balance training for chronic ankle instability. A brace can reduce recurrent sprains, but it should usually support rather than replace rehabilitation.

Surgery is considered when the ankle remains mechanically unstable and symptomatic despite a well-completed rehabilitation programme. Often after 6 months of good exercises, if it remains unstable, Mr Welck will consider surgery.

The usual operation is repair and tightening of the lateral ligaments, commonly a modified Broström procedure. Associated problems, such as peroneal tendon injury, ankle impingement or cartilage damage, may need treatment at the same time.

The decision should be based on symptoms, examination, activity goals, imaging and the quality of the remaining ligament tissue. Surgery is not required simply because an MRI describes an old ligament tear.

A specialist assessment can identify whether the problem is ligament instability, tendon injury, cartilage damage or another cause, and guide the right rehabilitation or surgical plan.

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You may also find these helpful: Ankle Ligament Repair (Broström) · Syndesmosis Injury (High Ankle Sprains) · Foot & Ankle Treatments