Recurrent Ankle Sprains

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Recurrent Ankle Sprains

What are Ankle Sprains and how do they occur?

  • Ankle sprains are one of the most commonly recurring among both general and athletic population.
  • The primary cause of a lateral ankle sprain typically involves the foot suddenly turning inwards with an added force on the body.
  • This twisting force injures the ligaments present on the outer side of ankle, namely anterior talofibular ligament (weakest and injures first), the calcaneofibular ligament (CFL) and/or the posterior talofibular ligament (PTFL).

What are Recurrent Ankle Sprains?

  • After the first episode, the chances of reinjuring the same ankle increases due to an impairment in the pre-injury state of muscles and ligaments of ankle.
  • Due to this, one can develop long standing pain or instability known as chronic ankle instability (CAI).
  • In CAI, the ankle feels unstable or ‘gives way’ usually while walking or doing other activities, but it can also happen in just standing, with other persistent symptoms such as pain, swelling, limited motion, weakness, etc.

What are the causes of recurrent ankle sprains?

Factors associated with repeated ankle sprains include:

  • Decreased muscle strength
  • Limited range of motion in the ankle joint
  • Reduced Balance
  • Impaired proprioception (joint position sense)
  • Ligamentous laxity
  • A high-arched foot type

What do the injury statistics say?

  • Almost 50% affected people continue to experience persistent symptoms such as pain, swelling, instability, and recurring issues for at least a year after the initial injury.
  • Around 10-30% of individuals who sustain acute sprain develop CAI.

What is the Treatment/Management Options?

Initiating physiotherapy promptly following the first episode of ankle sprain reduces the likelihood of recurrence.

  1. PRICE protocol: This protocol is advised for the initial management (24-76 hours) of acute ankle sprains. For more information on how to follow PRICE protocol, please refer our blog on ‘How to Manage Acute Injuries and Pain’
  2. External Support: Taping or Bracing the ankle helps in reduction of swelling, prevents recurrences, and helps in early return to sport.
  • Exercises: Following neuromuscular training helps decrease recurrence rate and enhances overall functional stability.
  • Ankle muscle strengthening
  • Balance training
  • Range of Motion exercises
  • Sport specific training drills (in later stages for athletes)

Note: These exercises should only be performed under the supervision of a physiotherapist.

Surgical Approach:

  • When instability persists or nonsurgical methods prove ineffective, the surgeon may suggest operative management.
  • Typically, this involves repairing or reconstructing the damaged ligaments. The choice of the most suitable surgical procedure is determined by the severity of instability and your activity level. Recovery duration varies based on the specific procedures undertaken.


  • Mugno AT, Constant D. Recurrent Ankle Sprain. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.
  • Sarcon AK, Heyrani N, Giza E, Kreulen C. Lateral Ankle Sprain and Chronic Ankle Instability. Foot Ankle Orthop. 2019 Jun 13;4(2).
  • Hertel J, Corbett RO. An Updated Model of Chronic Ankle Instability. J Athl Train. 2019 Jun;54(6):572-588. doi: 10.4085/1062-6050-344-18. Epub 2019 Jun 4.
  • Al-Mohrej OA, Al-Kenani NS. Chronic ankle instability: Current perspectives. Avicenna J Med. 2016 Oct-Dec;6(4):103-108.