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Rady Children's Specialists

Ankle Instability

Ankle injuries are one of the most common problems encountered by athletes. Most injuries are sprains from a rolling injury. A majority of ankle injuries can be treated with simple rest, ice, compression and elevation. The duration of activity limitation is dependent on the severity of the ankle injury, but in almost all cases, it should not be longer than three months. If your child experiences recurrent ankle sprains, it is likely that the previous sprains never fully healed, and the ankle is now unstable.


Symptoms of ankle instability include:

  • Recurrent episodes of “rolling over” the ankle.
  • Pain.
  • Swelling and bruising.
  • Limited ankle motion.
  • Difficulty walking.


Physical exam and a history about the recurrent nature of the injury will help diagnose the injury. An X-ray is very important to rule out a fracture. The younger you are, the more likely that you may sustain a fracture though one of the growth plates, rather than just an injury to the ligaments. An MRI is necessary to better evaluate the soft tissues (ligaments) around the ankle to guide treatment.


Treatment should begin with physical therapy and ankle bracing. If bracing stops the symptoms, this indicates that the diagnosis is accurate, and no further treatment is needed.  Physical therapy can improve ankle strength and motion, and promote proprioception, the innate sense of balance that the ankle has without any input from the brain.

If conservative management fails to return the athlete to sports, surgery can be done to repair the ligaments usually on the outer, or lateral, side of the ankle. Casting is done after surgery for a period of six weeks, which is followed by a course of physical therapy with the above mentioned goals prior to release to sports.