Ankle Instability

Recurring or persistent (chronic) pain on the outer (lateral) side of the ankle often develops after an injury, such as a sprained ankle. However, several other conditions may also cause chronic ankle pain.

Signs and Symptoms

  • Pain, usually on the outer side of the ankle. The pain may be so intense that you have difficulty walking or participating in sports. In some cases, the pain is a constant, dull ache.
  • Difficulty walking on uneven ground or in high heels

  • A feeling of giving way (instability)
  • Swelling

  • Stiffness
  • Tenderness

  • Repeated ankle sprains

Possible Causes for Chronic Lateral Ankle Pain

The most common cause for a persistently painful ankle is incomplete healing after an ankle sprain. When you sprain your ankle, the connecting tissue (ligament) between the bones is stretched or torn. Without thorough and complete rehabilitation, the ligament or surrounding muscles may remain weak, resulting in recurrent instability. As a result, you may experience additional ankle injuries. Other causes of chronic ankle pain include:

  • An injury to the nerves that pass through the ankle. The nerves may be stretched, torn, injured by a direct blow, or pinched under pressure (entrapment).
  • A torn or inflamed tendon

  • Arthritis of the ankle joint
  • A break (fracture) in one of the bones that make up the ankle joint

  • An inflammation of the joint lining (synovium)
  • The development of scar tissue in the ankle after a sprain. The scar tissue takes up space in the joint, thus putting pressure on the ligaments.

Evaluation and Diagnosis

The first step in identifying the cause of chronic ankle pain is taking a history of the condition. Your doctor may ask you several questions, including:

  • Have you previously injured the ankle? If so, when?
  • What kind of treatment did you receive for the injury?
  • Are there times when the pain worsens or disappears?

Your doctor may order several X-ray views of your ankle joint. You may also need to get X-rays of the other ankle so the doctor can compare the injured and non-injured ankles. In some cases, additional tests such as a bone scan, computed tomography (CT) scan, or magnetic resonance image (MRI) may be needed. Treatment will depend on the final diagnosis and should be personalized to your individual needs.

Both conservative (nonsurgical) and surgical treatment methods may be used. Conservative treatments include:

  • Anti-inflammatory medications such as aspirin or ibuprofen to reduce swelling
  • An ankle brace or other support. In the case of a fracture, immobilization to allow the bone to heal 

Surgical treatment options include:

  • Cleaning (debriding) the joint or joint surface

Follow your doctor's instructions carefully and complete the prescribed physical rehabilitation program. When you do return to sports, use an ankle brace rather than taping the ankle. Bracing is more effective than taping when it comes to preventing ankle sprains.


*Source:  American Orthopaedic Foot & Ankle Society®

This material was codeveloped by the American Academy of Orthopaedic Surgeons