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Orthopedics · Foot and ankle

Unstable ankle after a sprain

Does your ankle keep giving way, especially on uneven ground? Targeted rehabilitation with balance training and a brace usually helps. If the ankle still gives way afterward, reconstruction of the lateral ankle ligaments makes it firm again. If everything is in order, the procedure can take place as soon as within a week of the consultation.

Book an orthopedic consultation How the procedure works
  • No referral from a GP needed
  • Operated by Prof. MUDr. Radek Hart

Rehabilitation first, surgery only afterwards

1 weekthe procedure can be this fast
first
exerciserehabilitation and balance training are often enough
until the procedure
1 weekfrom the consultation, if everything is in order
ankle protection
6 weeksusually in a cast or brace after surgery
sports
3–6 monthsusually back to less demanding sports

When surgery is considered

An ankle that keeps giving way

On the outer side of the ankle, the lateral ligaments hold the joint; they connect the fibula to the talus and the heel bone. Most sprains heal on their own. Sometimes, however, the ligaments do not heal, or they heal stretched and loose. The ankle then stops being firm and keeps giving way. In roughly 15 to 20 % of cases it remains unstable after a serious sprain or after repeated minor injuries.

  1. It gives way again and again

    The ankle gives way mainly on uneven ground or with a quick change of direction, and the sprains keep recurring.

  2. A feeling of instability in the joint

    The ankle feels wobbly, you do not trust it and find it harder to put weight on it. Pain and swelling may be added. If pain after a sprain lasts longer than 4 to 6 weeks, it is a good idea to have the ankle examined.

  3. Why not to put it off

    Repeated sprains can over time damage the cartilage and bone in the joint and lead to wear. More about this on the page Ankle osteoarthritis.

  4. Fresh injury? Trauma clinic first

    The clinic is not an emergency service. If after an injury you cannot put weight on the foot, the ankle is badly swollen, has changed shape, or you heard a snap, it may be a fracture. Go to a trauma clinic or emergency department first. You can then come to us for a consultation, for a follow-up check, further treatment or a second opinion.

Diagram of the right ankle seen from the outside with healthy lateral ligaments: the anterior talofibular ligament runs from the fibula to the talus, the calcaneofibular ligament from the fibula down to the heel bone Healthy lateral ligaments 1 2 fibula tibia talus heel bone Diagram of the right ankle seen from the outside with an unstable joint: the anterior talofibular ligament is torn and the calcaneofibular ligament is stretched and loose, so the ankle does not hold firmly Loose and torn ligaments 1 2 1 2 torn ligament loose ligament
  • outline of the foot
  • bones
  • lateral ankle ligaments
  • 1anterior talofibular ligament
  • 2calcaneofibular ligament
Simplified diagram of the right ankle seen from the outside, not an actual image.

Treatment

No surgery first, when that is enough

Most sprains and unstable ankles can be treated without surgery. The most common cause of instability after a sprain is unfinished rehabilitation, so treatment starts with exercise. The doctor decides at the consultation which approach is suitable for you.

Step 1

Rehabilitation and balance

With a physiotherapist and at home.

  • Exercises for mobility and strength of the muscles around the ankle
  • Balance training, for example standing on one leg or exercises on a balance pad
  • Gradual return to activity: first without twisting, sudden changes of direction last

Step 2

Brace and sturdy footwear

For sports and on demanding terrain.

  • A brace or taping supports the ankle when returning to sports and to work
  • Footwear that holds the foot and ankle well
  • With markedly loose ligaments a brace is often not enough

Step 3

Surgery

When the ankle still gives way after months of rehabilitation.

  • Instability and pain persist even after months of exercise and non-surgical treatment
  • The examination confirms loose or torn ligaments
  • Cartilage or a tendon in the ankle is also damaged and needs to be treated

Not sure whether it is loose ligaments or weak muscles and balance? The examination will tell. Book a consultation

How the procedure works

From booking to going home

The aim of lateral ligament reconstruction is to make the ankle firm again. The loose ligament is shortened and sutured firmly. If that is not enough, it is replaced with a graft from your own tendon. The doctor will explain which approach suits your ankle based on the examination and images.

  1. Booking

    Online or by phone. A referral from a GP is not required.

    online or by phone

  2. Consultation and examination

    Prof. Hart examines the ankle and its stability. If needed he adds an X-ray, stress images or ultrasound, and may recommend an MRI.

    diagnosis and treatment plan

  3. Procedure

    Under anesthesia, the type of which the anesthesiologist recommends. After the procedure a plaster splint protects the ankle.

    within a week of consultation

  4. Going home

    On crutches, with the leg raised as high as possible. You must not drive yourself.

    check-ups and physiotherapy

Recovery and physiotherapy

The ligament needs time and exercise

A repaired ligament takes several weeks to heal. Put weight on the foot only as the doctor instructs; loading it too early can tear the ligament again. Physiotherapy is an essential part of treatment: without it there is a higher risk of spraining the ankle again. If needed, we follow up with physiotherapy right at the clinic.

Room of the short-stay ward at HR Clinic

  1. First 2 weeks: leg up

    Rest as much as possible and keep the leg raised so the swelling goes down. Keep the cast dry. The stitches are removed at the check-up after about 2 weeks.

  2. About 6 weeks of protection

    A cast usually protects the ankle for that long, then a brace for a few more weeks. The doctor decides at the check-up when you can start putting weight on the foot. You will receive the exact plan before the procedure.

  3. Physiotherapy

    It usually starts 4 to 6 weeks after surgery. It helps reduce swelling and restore mobility, strength, balance and stability of the ankle.

  4. Work, driving and sports

    You can return to seated work after about 4 weeks, if you can keep your leg raised. You can usually drive after about 2 months. You usually return to less demanding sports after 3 to 6 months, and to demanding ones within a year.

Prof. MUDr. Radek Hart, Ph.D., FRCS, MHA

Who operates

Prof. MUDr. Radek Hart, Ph.D., FRCS, MHA

Orthopedic surgeon and trauma specialist of the musculoskeletal system, head physician of HR Clinic. At a clinic in Vienna he is head of the foot outpatient clinic. He sees patients in Znojmo and Vienna; after a consultation in Vienna the procedure can be performed in Znojmo.

More about Prof. Hart Professional website ortho-hart.at

Price We will tell you the price of the procedure at the consultation, depending on the findings and the extent of the procedure.

Common questions

What patients ask most often

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Achilles tendon pain: when to pay attention and how to treat it How it works at HR Clinic

Other foot and ankle problems

Ankle osteoarthritis Achilles tendon Flatfoot Bunion and forefoot
I only recently sprained my ankle. Should I come?

A fresh injury belongs first in a trauma clinic or emergency department, especially if you cannot put weight on the foot, the ankle is badly swollen or has changed shape. Most sprains then heal on their own and usually improve within 2 weeks. Come for a consultation if the ankle keeps hurting, swelling or giving way after treatment.

My ankle often gives way. Do I need surgery?

Not necessarily. Surgery for a sprained ankle is rather the exception. Consistent rehabilitation with balance training, possibly a brace, helps most people. Surgery comes into consideration when the ankle still gives way and hurts after months of such treatment.

Will the operation hurt?

You feel nothing during the procedure. Afterward medication relieves the pain, and keeping the leg raised helps too. If the pain does not start to improve within a few days, contact us.

When will I walk without crutches?

It depends on the findings and the approach. Usually a cast protects the ankle for about 6 weeks, and once it is removed most people walk normally, with a brace. Do not put weight on the foot before the doctor allows it; the repaired ligament could tear again.

Can an unstable ankle lead to osteoarthritis?

Repeated sprains can over time damage the cartilage and bone in the joint and lead to wear. That is one reason it makes sense to address an unstable ankle. You can find out how ankle osteoarthritis is treated on the page Ankle osteoarthritis.

How long will I stay at the clinic?

The stay at the clinic lasts 24 hours at most.

Do I need a referral from my GP?

No. It is enough to book online or by phone.

How quickly can I have the procedure?

If everything is in order, the procedure can take place as soon as within a week of the consultation. We will arrange the date according to the result of the examination.

Booking

Book an orthopedic consultation

Online or by phone, at the clinic in Znojmo. A referral from a GP is not required.

Book a consultation
Book a consultation