Most ankle sprains settle within a few weeks. Some do not. If your ankle still feels weak, keeps giving way, or aches months after the injury, the sprain may not have healed as well as you hoped. This is a common and treatable problem called ankle instability.
This guide explains the signs that a sprain has not healed properly, why it happens, and what a foot and ankle specialist can do to help. It is written for patients in the UK and signposts you to qualified clinical care when that is the right next step.
What healthy ankle healing should look like
A sprain happens when the ligaments that hold the ankle together are overstretched or torn. The anterior talofibular ligament (ATFL) is the one most often injured1. Most sprains are graded from one (mild) to three (a full tear).
With the right early care and rehabilitation, healing usually follows a clear pattern. Swelling settles, movement returns, and the ankle starts to feel steady again. A mild sprain may recover in one to two weeks. A more severe sprain can take several weeks or longer.
You can read more about how each grade is managed in our guide on how an ankle sprain is treated. The key point is simple: by around six to eight weeks, most people feel close to normal4. If you do not, it is worth paying attention.
Six signs your sprain did not heal properly
Some sprains leave lasting problems even after the pain has eased. Watch for these signs that your ankle has not fully recovered:
- Your ankle keeps giving way. It buckles or rolls during normal activities, not just sports.
- It feels weak or unreliable. You no longer trust it on stairs, kerbs, or uneven ground.
- You have repeated sprains. The same ankle keeps turning over, sometimes from minor movements.
- Pain or swelling lingers. Discomfort continues beyond six to eight weeks despite rehabilitation.
- Your balance has changed. Standing on one leg feels harder than it used to.
- You are avoiding activities. Fear of the ankle letting you down has changed how you move.
If you recognise one or more of these signs, your sprain may have led to ankle instability. A foot and ankle specialist can assess what is happening and recommend the right next step.
Not sure if your ankle has healed as it should? Our team can arrange a private assessment at short notice. You can contact the clinic to talk through your symptoms.
What is chronic ankle instability?
Chronic ankle instability (CAI) is the medical term for an ankle that keeps giving way after a sprain. It develops when a sprained ligament does not heal at its normal length or strength, leaving the joint looser and harder to control.
CAI is common. Research suggests that around 7 in 10 people who sprain an ankle go on to have some ongoing symptoms2, and as many as 4 in 10 develop lasting instability after a first sprain3. So if your ankle still feels unreliable, you are far from alone.
Doctors usually describe two types, and many people have a mix of both.
Mechanical instability
This is when the ligament is physically loose or stretched, so the joint moves more than it should. Your specialist can often feel this looseness during an examination, and a scan can confirm it.
Functional instability
This is when the ankle feels unstable even though the ligaments are not very loose. It is usually linked to reduced proprioception, which is your body’s sense of where the joint is in space. Poor proprioception after a sprain is a key reason ankles keep rolling3.
Why some sprains do not heal properly
A sprain that does not settle down is rarely down to bad luck alone. Several things can get in the way of full recovery. Understanding them can help you and your clinician put things right.
- Too little rehabilitation. Resting until the pain goes, then stopping, often leaves the ankle weak and poorly balanced.
- Returning to activity too soon. Going back to sport before the ankle is ready raises the risk of another sprain.
- A missed or underestimated injury. A more severe tear, or a small fracture or cartilage injury, can be missed at first.
- Repeated sprains. Each new sprain can stretch the ligaments a little further and make the next one more likely.
- Individual factors. Naturally loose joints, high-arched feet, or certain sports can all increase the risk.
Mr Francesc Malagelada
Mr Francesc Malagelada is a highly respected Consultant Trauma and Orthopaedic Surgeon based at the Royal London Hospital, the largest Trauma Centre in the UK. He has a special interest in foot and ankle surgery and treats common conditions such as bunions, sports injuries, ligament damage, tendon issues, as well as complex conditions that require reconstruction surgery. Mr Malagelada takes a patient-centric approach to care and offers both surgical and non-surgical options to adapt to each patient’s lifestyle.
Why ankle instability is worth treating
It can be tempting to live with an ankle that gives way now and then. The trouble is that repeated rolling does not just risk another painful sprain. Over time, it can wear the cartilage inside the joint.
Long-standing instability has been linked to a higher risk of ankle osteoarthritis later in life2. Getting an early assessment may help protect the joint, as well as your confidence and activity levels. Your consultant will assess your individual risk and explain your options.
How a specialist assesses your ankle
A foot and ankle specialist starts by listening to your story: how the original sprain happened, how it was treated, and what your ankle does now. They will then examine the joint to check its movement, strength, and stability4.
If a clearer picture is needed, imaging can help. An ultrasound or MRI scan can show whether the ligaments have healed and whether there is any damage inside the joint. Private imaging can usually be arranged promptly, so you are not left waiting for answers.
How ankle instability is treated
The good news is that most people improve without surgery. Treatment almost always starts with a structured rehabilitation programme, and surgery is only considered if that does not give you a stable, reliable ankle.
Rehabilitation first
A physiotherapist can guide a programme that rebuilds strength, balance, and proprioception. Balance work, such as standing on one leg or using a wobble board, is especially important. Simple home exercises can help too, and our guide to foot and ankle stretches is a useful starting point.
Surgery if needed
If your ankle is still unstable after a full course of rehabilitation, surgery to repair or tighten the ligaments may be an option. Two well-established approaches are used, and your surgeon will advise which suits you best.
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Procedure
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What it involves
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Typical use
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Modified Broström-Gould
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The damaged ligaments are tightened and reattached through a small open incision.
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A long-established, widely trusted repair.
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All-inside arthroscopic repair
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The ligaments are repaired through two tiny keyhole portals, and the joint is checked at the same time.
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A minimally invasive option with small scars.
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Mr Francesc Malagelada performs lateral ligament reconstruction using minimally invasive and arthroscopic techniques where appropriate, and has co-authored published research comparing keyhole and open repair5. The right choice depends on your ankle, your goals, and what your surgeon finds during the assessment.
When to see a foot and ankle specialist
It is worth booking an assessment if any of the following apply to you:
- Your ankle still gives way during everyday activities.
- You have had two or more sprains on the same ankle.
- Pain or swelling has lasted beyond six to eight weeks of rehabilitation.
- You cannot get back to the activities or sports you enjoy.
- You felt severe pain, heard a pop, or could not bear weight at the time of injury.
An earlier review usually means simpler treatment and a faster return to the things you enjoy. In the UK, you can see a private foot and ankle specialist without a GP referral, so you do not need to wait.
If your ankle keeps letting you down, the team at Foot and Ankle Treatments can help. Call 020 8629 0932 or book an appointment to arrange an assessment at one of our London clinics. Both self-pay and insured patients are welcome, and video consultations are available.
How to protect your ankle while you wait
While you arrange an assessment, there are simple steps that may help. They will not replace a proper diagnosis, but they can lower the chance of another sprain in the meantime.
- Build strength and balance. Gentle, regular exercises for the ankle and lower leg help the joint feel steadier.
- Choose supportive footwear. Shoes that fit well and support the foot can reduce the risk of rolling the ankle.
- Take care on uneven ground. Slow down on kerbs, stairs, and rough surfaces, where most sprains happen.
- Consider a brace for sport. A simple ankle brace or supportive taping may add stability during activity. Ask a clinician what is right for you.
- Warm up properly. A few minutes of movement before exercise prepare the joint and the muscles around it.
These steps support your ankle, but they do not fix an underlying ligament problem. If your ankle keeps giving way, an assessment is still the most important next step.
What happens at your first appointment
Knowing what to expect can make a first appointment feel less daunting. The aim is to understand your ankle and agree a plan that fits your life.
Your specialist will ask about your original injury, how it was treated, and what your ankle does now. They will examine the joint, checking its movement, strength, and stability, and compare it with your other ankle. If needed, they may arrange a scan to look at the ligaments and the joint surface in more detail.
From there, you will talk through the options together. For most people, this means a clear rehabilitation plan. For a smaller number, it may include a conversation about surgery. Either way, you should leave with a better understanding of what is happening and what to do next.
Who is most at risk of ankle instability?
Anyone can develop ankle instability after a sprain, but some people are more prone to it than others. Knowing whether you are at higher risk can help you take rehabilitation seriously from the start.
You may be more likely to develop instability if you have sprained the same ankle before, if you returned to sport quickly after a previous injury, or if you have naturally flexible joints. People who play sports that involve jumping, cutting, or running on uneven ground also tend to be at greater risk.
Being in a higher-risk group does not mean instability is inevitable. It simply means that good rehabilitation, sensible footwear, and a timely assessment matter even more for you.
Frequently asked questions
How do I know if my ankle sprain has not healed?
The clearest signs are an ankle that keeps giving way, feels weak or unreliable, or sprains again easily. Lingering pain or swelling beyond six to eight weeks is another clue. If this sounds like you, a specialist assessment can confirm what is going on.
What is chronic ankle instability?
Chronic ankle instability is an ankle that repeatedly gives way after a sprain. It happens when the ligaments and the ankle’s sense of position do not fully recover, leaving the joint harder to control.
Can a sprained ankle heal on its own?
Many do, especially mild sprains with good early care. Even so, structured rehabilitation lowers the risk of the ankle becoming unstable. Rest alone is often not enough.
Do I need surgery for ankle instability?
Usually not. Most people improve with rehabilitation that rebuilds strength and balance. Surgery is considered only when the ankle stays unstable despite a full programme, and your surgeon will discuss whether it is right for you.
How long does ankle instability take to recover?
With a good rehabilitation programme, many people notice real progress within a few months. Recovery times vary from person to person, so your clinician can give you a more personal estimate. Sticking with the full programme, including the balance and strength work, tends to give the most reliable results.
Can ankle instability lead to arthritis?
Long-standing instability can place extra stress on the joint and has been linked to a higher risk of ankle arthritis over time. Treating instability early may help reduce that risk. A timely assessment gives you the best chance of protecting the joint for the long term.
References
- Doherty C, Delahunt E, Caulfield B, Hertel J, Ryan J, Bleakley C. The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies. Sports Medicine. 2014. (How common ankle sprains are and which ligament is most often injured)
- Herzog MM, Kerr ZY, Marshall SW, Wikstrom EA. Epidemiology of ankle sprains and chronic ankle instability. Journal of Athletic Training. 2019. (Proportion with ongoing symptoms after a sprain and the link to osteoarthritis)
- Hertel J, Corbett RO. An updated model of chronic ankle instability. Journal of Athletic Training. 2019. (Proportion developing chronic instability and the role of proprioception)
- NICE Clinical Knowledge Summary: Sprains and strains. National Institute for Health and Care Excellence. (Assessment, management, recovery timescales, and when to refer)
- Guelfi M, Baalbaki R, Malagelada F, Dalmau-Pastor M, Vega J. Arthroscopic all-inside ligament repair has similar or superior clinical outcomes compared to open repair for chronic ankle instability. Knee Surgery, Sports Traumatology, Arthroscopy. 2023. (Comparison of keyhole and open surgical techniques)