Warning

Chronic ankle instability is a condition characterized by a recurring “giving way” of the outer (lateral) side of the ankle. This condition often develops after repeated ankle sprains. Usually the “giving way” occurs while walking or doing other activities.

People with chronic ankle instability often complain of:

  • A repeated turning of the ankle, especially on uneven surfaces or when participating in sports
  • Persistent (chronic) discomfort and swelling
  • Pain or tenderness
  • The ankle feeling wobbly or unstable

Causes

Chronic ankle instability usually develops following an ankle sprain that has not adequately healed or was not rehabilitated completely. When you sprain your ankle, the connective tissues (ligaments) are stretched or torn. The ability to balance is often affected. Proper rehabilitation is needed to strengthen the muscles around the ankle and “retrain” the tissues within the ankle that affect balance. Failure to do so may result in repeated ankle sprains.

Repeated ankle sprains often cause – and perpetuate – chronic ankle instability. Each subsequent sprain leads to further weakening (or stretching) of the ligaments, resulting in greater instability and the likelihood of developing additional problems in the ankle.

Who to refer, who not to refer, how to refer

Who to Refer

  • Those who have failed primary care management

Urgent Referral Criteria

  • If trauma <1/12

Who Not to Refer

  • Those who have not tried primary care management.

Additional Info 

  • 99% of these will go to Podiatry for strengthening exercise– refer to Podiatry unless they have had input from Podiatry already

Imaging

  • NWB Ankle Xray (Ideally < 1yr old) if Over 50 years old

How to refer

We accept referrals through SCI gateway for those who are based in Scotland.

We also accept e referrals through the below email address using the attached form for those who are based just on the other side of the border. 

E- Referral Email address - bor.orthoreferrals@borders.scot.nhs.uk

Referral form - E-Referral to Orthopaedics (Non Sci-Gateway)      

Primary care management

  • Physio rehab- strengthening with proprioception and plyometrics over extended period.
  • Tried brace ankle for 2/12
  • Regular maximum multimodal analgesia
  • Education
  • BMI >35 engage in wellbeing support

Resources and links

Appropriate Ankle Braces

Malleotrain “S”-  Ankle Brace

 https://www.podobrace.co.uk/shop/product/bauerfeind-malleotrain-s-ankle-support/

Aircast Ankle Brace

 link

Primary Care Foot Pathway  - developed by First Contact Practitioners / Podiatry (To be confirmed, will update when available)

Editorial Information

Last reviewed: 31/07/2025

Next review date: 31/07/2027

Author(s): Mr Roshan Raghavan.

Author email(s): Roshan.Raghavan@nhs.scot.