Why Your Ankle Keeps Giving Way

You sprained an ankle once. Maybe years ago. It swelled, you limped for a week, then it was good enough to walk on and you stopped thinking about it. Now it turns over. On a gravel shoulder, stepping off a curb, coming down stairs, on a wet dock. The usual assumption is that the ankle is weak. That is part of it, and not the main part.

If you rolled it this week and it is still swollen, is RICE still the right advice for injuries covers the first days. This page is about the ankle that heals and then starts letting you down.

Why a sprained ankle keeps re-spraining

When you roll an ankle you stretch or tear the ligaments on the outside of the joint. They heal, usually well enough that the ankle feels normal on flat ground. What often does not heal is something most people are never told about. Ligaments are not only straps. They are full of nerve endings that report the joint's position back to your nervous system, constantly, below anything you would notice. The ankle leans on that position sense harder than almost any other joint, because it is the one dealing with the ground.

Tear the ligaments and you damage that reporting system along with the strap. The ankle stops describing its own position accurately, so corrections that normally happen automatically arrive a fraction of a second late. On flat pavement that costs nothing. On a loose rock or the edge of a step, the ankle is past the point of no return by the time the correction lands.

That is why the pattern is so specific. Your ankle does not give way in the kitchen. It gives way on uneven ground. It is also why strength work alone often fails to fix it. A muscle told too late is still too late.

The other half of the problem

The muscles down the outside of the lower leg, the ones that turn the foot outward, are what resists a roll, and they are usually still weaker on the injured side long after the pain has gone. The ankle also stiffens after an injury, so the foot meets the ground differently and you land differently without deciding to.

Why it is worth interrupting

Repeat sprains accumulate. Each one adds a little more to the same tissue, and ankles that have rolled many times are more likely to end up with cartilage damage and arthritis. That is not a reason to be alarmed about an ankle that has gone twice. It is a reason to break the pattern rather than live with it.

St. Thomas gives it plenty of chances. Between hillside steps, broken sidewalk edges, docks and a moving boat deck, an ankle here rarely lands on anything predictable.

What actually helps

The piece most people miss is retraining the position sense itself. The nervous system relearns it by being asked to: balance work on the affected leg, then with vision taken away, then on an unstable surface, then under the quick unplanned demands real ground makes. Alongside that, strength for the muscles that control the foot, and restoring the lost ankle motion.

We are not putting sets and repetitions on a web page, because the starting point depends on what the exam finds. Taping or bracing has a place during a return to activity, as support while the retraining catches up, not as the answer itself.

When it is not simple instability

Some ankles give way because something structural is in the way rather than because the control is off. An ankle that locks or catches partway through a movement, one that swells substantially after every episode, or one that took a hard injury and was never imaged. A chip off the bone, or damaged cartilage on top of the ankle bone, can sit for years being treated as a weak ankle. That needs imaging, not balance work.

What an exam settles

A first visit is a history and a hands-on exam: how many times it has gone, how it goes, and how little it now takes. We test the ligaments, the ankle's range of motion, the strength of the muscles that turn the foot out, and how long you can balance on that leg compared with the other. Digital x-rays are taken on site if a bone injury is in question.

Dr. Keys is the Chair of the Virgin Islands Board of Chiropractic Examiners, a member of the Virgin Islands Chiropractic Society, and the International Chiropractors Association representative for the U.S. Virgin Islands.

Pain in the cord at the back of the ankle is a different problem, covered on our Achilles tendinitis page. What we use is on our services page.

When you should see someone else

Call 911 or go to the nearest emergency room if the foot is cold, pale or numb, which is a circulation emergency, or if you cannot put weight on the ankle at all straight after an injury.

Get it examined, with imaging, rather than starting balance work, if:

• Pressing on the bones of the ankle is tender after a fresh injury, which raises the question of a fracture
• The ankle locks or catches partway through a movement
• It swells substantially with every episode rather than settling quickly

Getting seen

Tradewinds Chiropractic & Wellness is in the VI Medical Foundation Building, Suite 202, 9150 Estate Thomas, St. Thomas, USVI 00802, just east of Charlotte Amalie. Hours are Mon, Wed, Thu: 10:00 am to 1:00 pm and 3:00 pm to 7:00 pm. Tue, Fri: 7:00 am to 2:00 pm. Closed Sat and Sun.

Call (340) 690-4994. We take walk-ins and same-day appointments. New patient forms are on the forms page to print and fill in.

Questions patients ask

Why does my ankle keep giving way?

Usually because a previous sprain damaged more than the ligament. Ligaments carry the nerve endings that report the joint's position to your nervous system, so a tear leaves the ankle reporting its own position late or inaccurately. The automatic corrections that keep you upright arrive a fraction of a second behind, which is fine on flat ground and not fine on a curb, a step or a rock.

My ankle rolls easily after a sprain. Is it just weak?

Weakness in the muscles that turn the foot outward is part of it, and it is rarely the whole story. The position sense in the joint is the piece most people are never told about, and it explains why the ankle behaves on pavement and betrays you on uneven ground. It also explains why strengthening alone often does not stop the rolling.

Can a weak ankle that keeps turning over be fixed?

In most cases it can be improved a great deal. The work has three parts: retraining balance and position sense, strengthening the muscles that control the foot, and restoring the ankle motion that was lost after the injury. The right starting point depends on what an exam finds, which is why we do not publish a set-and-repetition program here.

Should I wear a brace if my ankle keeps giving way?

Taping or bracing is reasonable as temporary support while you get back to activity, and it can keep you moving while the retraining takes hold. It is not a fix on its own, because it does nothing about the position sense or the strength. Treat it as a bridge rather than a destination.

Do I need an x-ray for an ankle that keeps giving way?

Not always, but there are specific reasons to image one. Tenderness on the bones after a fresh injury, an ankle that locks or catches, one that swells substantially every time it goes, or one that took a significant injury and was never imaged all point toward imaging rather than starting rehabilitation. An ankle that simply feels unreliable on rough ground usually does not need it.