Why You Keep Spraining Your Ankle
Rolled the same ankle again? Standard rehab often misses why chronic ankle instability keeps coming back. I break down what's actually needed to fix it.
CHRONIC ANKLE INSTABILITYSPORTS PODIATRY
Scott Rayment
4/27/20264 min read
You've rolled the same ankle again. Maybe it was a cut, a landing, a step off a kerb that shouldn't have mattered. And here you are, back to square one.
If this is the third time, or the fifth, or the tenth, you're probably not unlucky. This may well be chronic ankle instability. And the reason it keeps happening is likely not what you've been told.
What Chronic Ankle Instability Is
Chronic ankle instability (CAI) isn't just "a weak ankle." It's a specific clinical picture: recurrent lateral ankle sprains, a persistent feeling of giving way, and a loss of trust in the joint when you're moving at speed or under pressure.
Research indicates that around 40% of people who sustain a lateral ankle sprain go on to develop CAI (Herzog et al., 2019; Doherty et al., 2016). The ankle heals. The underlying problem often doesn't.
Two components usually coexist:
Mechanical instability, structural laxity in the lateral ligaments (ATFL and CFL) from repeated stretching or tearing.
Functional instability, deficits in proprioception, neuromuscular control, and joint position sense that persist long after the ligament looks healed on imaging.
A lot of standard care addresses the mechanical component and sends the athlete back to sport. The functional piece often gets less attention. That gap is a big part of why the problem repeats.
Why "You're Fine, Just Strengthen It" Isn't the Full Picture
Standard ankle rehab typically looks like this: rest, ice, compression, a few weeks of calf raises and single-leg balance on a wobble board, then return to sport. Then it rolls again.
The exercises themselves aren't wrong. It's usually the sequencing and specificity that fall short.
Your nervous system has learned to mistrust the ankle. The proprioceptors, sensors in and around the joint that tell your brain where your foot is in space, are firing inaccurately. When you cut hard or land from a jump, your brain is working from bad information. Calf raises alone don't fix that.
What tends to work is progressive neuromuscular retraining under increasing load, followed by sport-specific exposure at competition-relevant speeds and directions, in that order, with clear criteria to advance between phases (Donovan & Hertel, 2012). A lot of rehab progresses on a calendar rather than on demonstrated readiness. That's the gap worth closing.
What Sports Podiatry Adds to the Picture
Physiotherapy is a genuinely good starting point for acute ankle management, and does the rehab and load management side of things well. What sports podiatry adds is a structural and biomechanical layer that sits outside that scope, and it's often part of why the problem persists.
From a podiatry perspective, that includes things like:
Foot posture and how it affects lateral ankle loading mechanics
Subtalar joint mobility and its contribution to inversion injury risk
Tibial alignment and how it shifts stress onto the lateral structures
Footwear, and whether it's supporting or working against stability
Whether orthotic intervention meaningfully changes the loading picture
For a lot of athletes, one of these factors is part of why the ankle keeps going. You can do excellent neuromuscular rehab, and if you're loading a pronated foot in a shoe with no lateral support through a repeated cutting pattern, you're working against the structure the whole time. Addressing the mechanics alongside the neuromuscular work tends to change the outcome more than either approach alone.
A Structured, Three-Phase Approach
The evidence on CAI rehab is reasonably clear: a structured, progressive program addressing proprioception, neuromuscular control, progressive loading, and sport-specific demands, in sequence, with criteria to advance, is associated with better outcomes than generic, calendar-based exercise programs (Donovan & Hertel, 2012).
Phase 1: Stabilise (Weeks 1-3). Restore joint position sense, address the mechanical side, and build the neuromuscular foundation. Many people notice an improvement in joint confidence during this phase, though this varies from person to person. This isn't the phase for aggressive loading.
Phase 2: Load (Weeks 4-8). Progressive, sport-specific loading. This is where a lot of generic rehab falls short. Lateral cutting, explosive landing, rapid deceleration, these are the conditions where the ankle tends to give way. If rehab never progressively replicates these conditions, the ankle isn't being prepared for what competition will actually demand of it.
Phase 3: Perform (Weeks 9-12). Full performance integration, return-to-sport milestones, and a longer-term maintenance strategy. The aim isn't just getting back to training. It's building genuine confidence to compete without the ankle giving way.
How to Know If This Applies to You
This pattern is worth paying attention to if a few of these sound familiar:
You've sprained the same ankle more than once
The ankle feels unstable on uneven ground, even when it doesn't hurt
You hesitate on cuts or landings because you don't fully trust the joint
You've been told the ankle has "healed," but it doesn't feel right in sport
You've done standard rehab and the problem keeps returning
If that sounds like you, the ankle likely isn't just weak. It may be a problem that hasn't been fully addressed yet, not one that's failed to respond to treatment altogether. Take my FREE online self-assessment for chronic ankle instability.
A quick safety note: if you're dealing with sharp pain, swelling, bruising, or can't bear weight right now, that points to an acute injury, not chronic instability, and is worth getting assessed before starting any structured programme.
What to Do Next
The DynamicStep Foot and Ankle Performance Course is a fully online, 12-week program built by Sports Podiatrist Scott Rayment specifically for people dealing with recurrent ankle sprains or chronic ankle instability. Three phases, clear progression criteria, and sport-specific loading built into Phase 2, built around the exact problem outlined above.
It's available as a $79 AUD PDF Minimum Manual (the complete program, exercise cards, checkpoints, and QR-linked demonstration videos) or a $109 AUD Full Package with an interactive desktop and mobile-optimised version for tracking progress from any device.
Results vary based on individual presentation. This is general education, not personalised medical advice. If you're experiencing an acute injury, seek assessment before starting a structured rehab programme.
References
Donovan L, Hertel J. A new paradigm for rehabilitation of patients with chronic ankle instability. Phys Sportsmed. 2012;40:41-51.
Doherty C, Bleakley C, Hertel J, Caulfield B, Ryan J, Delahunt E. Recovery from a first-time lateral ankle sprain and the predictors of chronic ankle instability: a prospective cohort analysis. Am J Sports Med. 2016;44(4):995-1003.
Herzog MM, Kerr ZY, Marshall SW, Wikstrom EA. Epidemiology of ankle sprains and chronic ankle instability. J Athl Train. 2019;54(6):603-610.
