Your ankle’s movement up and down is known as dorsiflexion and plantar flexion. It isn’t supposed to move side to side. In fact, any side-to-side motion in your foot comes from the three joints of your hindfoot — not your ankle.
But with ankle instability, the ankle moves in an abnormal way. This is because the ligaments have stretched and no longer hold the ankle stable.
People with ankle instability often have a feeling of their ankle “giving out.” In other words, it twists funny when you step on a small rock or a crack. Where a strong ankle will catch little missteps, an unstable one will give way.
How Does Ankle Instability Happen?
Ankle instability happens because of repeated ankle sprains. There is often an initial sprain, perhaps a severe one as a young athlete or weekend warrior.
Even when healed, a severe sprain can leave the ligaments strained and stretched. This means the ligaments aren’t as strong. You are then more likely to re-sprain the ankle, even from small moves.
Even with a mild re-sprain — when the pain goes away fairly quickly — the ankle often doesn’t feel quite right. You feel a bit less stable and like one wrong move might send you toppling. This is because the ligaments have stretched yet again.
About 85% of people will heal fine after an initial ankle sprain. But about 15% will wind up with ankle instability, whether it’s subtle or severe. You may roll your ankle a few times before you notice that it’s happening more often.
Ankle instability sometimes results in swelling and pain. But other times, it’s a feeling of wobbliness that increases with activity. If you try to balance on the affected foot, it will likely be difficult.
How to Treat Ankle Instability
You don’t need to have a major injury to seek treatment. If your ankle is feeling unstable or wants to give way, it’s a good idea to see a doctor. Because even a little bit of instability can lead to the next major injury.
First, the doctor will examine your ankle and your range of motion. They’ll look for swelling and tender spots.
For acute injuries, where there is pain, swelling, and difficulty walking, rest, ice, compression, and elevation (RICE) is still a first-line treatment. An x-ray helps determine if there’s a break, and an MRI lets the doctor see the soft tissue of the ankle.
Depending on the diagnosis, you might get anything from an ankle corset (a lace-up figure-eight apparatus) to a walking boot. Anti-inflammatory medications can help with pain and inflammation.
Some people may need surgery if their ligaments are severely damaged. Surgeons can do ankle ligament reconstruction surgery to create stability in the ankle.
Physical Therapy for Ankle Instability
Physical therapy is key to rehabbing a sprained ankle to either prevent or heal instability. This includes coordination exercises.
For example, practicing balancing on one foot (the affected foot) is a good way to retrain your proprioception. Proprioception is how you know the position of your joint. In other words, how you sense what’s happening in your foot in relation to the space around you.
Many physical therapists start by having a patient stand on one foot with eyes open, holding on to a countertop or chair. Then when you get better at that, you balance without hanging onto anything. Finally, you balance with your eyes closed.
Therapists generally have people aim to balance, with their eyes closed, for 30 seconds at a time. Practicing this 30-second hold multiple times a day, for several weeks, greatly helps improve ankle stability. You are retraining the sensors in your ligaments to connect with your brain.
Therapists may also suggest other strengthening exercises, such as calf raises or exercises with stretchy exercise bands.
These exercises, together with balance training, can go a long way to prevent further injury or rehab an existing one.
Never hesitate to see the doctor if your ankle doesn’t feel right or feels like it might give out. It’s always better to treat ankle instability before it causes an injury, rather than after.