© Ali Abbasian
Website Designed ByIf your ankle keeps giving way after a sprain, the ligaments on the outside of the ankle may not have healed properly. I treat chronic ankle instability in London, at Guy’s and St Thomas’ and in private practice at HCA hospitals. When physiotherapy hasn’t worked, a Broström (Brostrom) ligament repair can restore stability and get you back to normal activity and sport. Around 9 out of 10 people have a good or excellent result.
On this page
The two ligaments most often injured in an ankle sprain are the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL). They attach the fibula to the talus and the calcaneus (heel bone), and stop your ankle rolling inwards. Most sprains heal well, but sometimes the ligaments heal stretched or weak, and the ankle stays unstable.
Common symptoms include:
I will examine your ankle to test the ligaments and look at the shape of your foot, as a high arch can make instability more likely. I will also check whether your joints are generally very flexible, as this affects the results of surgery. An MRI scan shows the ligaments and helps rule out related problems, such as cartilage damage or a peroneal tendon tear.
Most people with ankle instability do not need surgery. Physiotherapy works because the muscles that control the ankle, particularly the peroneal muscles, can be trained to compensate for some ligament laxity. Balance and strength work form the basis of this.
People who are hypermobile, or who have a high-arched foot, may recover more slowly. Insoles and ankle braces can help. A brace in the first few weeks lets swelling settle and allows the ligaments to heal without too much tension, and you may need to wear one for sport to protect the ankle.
If your ankle is still giving way after a proper course of physiotherapy, surgery may be the next step.
This is normally a day-case procedure under general anaesthetic. I make a curved incision about 5 cm long on the outside of the ankle. There are several repair techniques; I reattach the injured ligaments to the fibula using strong stitches secured into the bone. The operation takes 30 to 45 minutes and the wound is closed with absorbable stitches.
A tourniquet is placed around your upper thigh during surgery to control bleeding, so your thigh may feel sore for a day or two afterwards.
After the operation you will be in a below-knee plaster back slab (a half plaster held with bandages). You will not be allowed to put weight on the foot and will be given crutches. The plaster comes off at your first appointment two weeks after surgery, when you will be given a boot.
Around 9 out of 10 people have a good or excellent result, with a stable ankle and a return to normal activities. Further surgery is rarely needed: in most studies fewer than 1 in 20 people need another operation over the following 5 to 10 years.
Results are less reliable in people with very flexible (“double-jointed”) joints, who are more likely to have the ankle give way again. If this applies to you, I will discuss it with you before deciding on surgery.
Complications affect roughly 1 in 10 to 1 in 6 people, and most are minor and temporary. These risks should be read alongside the general risks of foot and ankle surgery and anaesthesia.
You will be in a plaster back slab and non-weightbearing on crutches. Rest and elevate your leg as much as possible. The local anaesthetic given during surgery wears off 6 to 12 hours after the operation; a nerve block can last up to 24 hours.
Move around regularly to reduce the risk of blood clots and keep the rest of your leg muscles working, but avoid having the leg down for more than 20 minutes at a time, as it will swell and become painful.
At two weeks the plaster is removed, the wound checked and most patients are given a boot. You can then start putting weight on the foot and stop using crutches when you feel confident.
You can start gentle ankle exercises out of the boot, taking care not to turn the ankle in or out. A few sessions with a physiotherapist at this stage can help. You can return to most daily activities, though swelling may persist after heavy use, so keep elevating and icing when needed.
You can shower or bathe out of the boot if you are careful. Once the wound has healed it can get wet, as long as you dry it well.
I will see you again at six weeks, when the boot can usually be stopped and formal physiotherapy begins.
Avoid impact activity and sport, but you can start low-impact exercise such as cycling and swimming. Towards the end of this period you may be able to start jogging on a treadmill and using a cross trainer.
You can gradually return to sport, starting with straight-line activities such as running and cycling, then building up to sports that involve cutting and turning, such as football, hockey or netball. I recommend wearing a sports ankle brace, such as the Aircast A60, for sport during the first year to protect the repair.
For around 9 out of 10 people, yes. A small number have the ankle give way again, usually after a new injury, and the risk is higher if your joints are very flexible.
If you can work from home, or get to work safely and keep your foot raised under a desk, you may be able to return within a few days. Otherwise, plan on two weeks, as commuting on crutches is difficult. Manual work will take longer, and we can discuss this based on your job.
You should not drive while in plaster or a boot on your right leg. Most people return to driving once the boot is stopped at around six weeks. If the surgery is on your left ankle and you drive an automatic, you may be able to drive sooner. Check with your insurer before driving.
Low-impact exercise from six weeks, straight-line running from around three months, and full contact or pivoting sports after that, guided by your physiotherapist.
If your ankle keeps giving way, I can assess whether physiotherapy or surgery is the right option for you. I see patients privately at HCA hospitals in London. Request an appointment or message us on WhatsApp.