Chronic lateral ankle instability — the persistent feeling that the ankle will “give way” with walking, running, or even standing — is one of the most functionally limiting conditions in sport and daily life. It develops after incompletely healed lateral ankle ligament sprains, particularly injuries to the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL). When physical therapy fails to provide adequate stability, surgical ligament repair restores mechanical ankle stability and allows return to full activity. Dr. Tom Biernacki at Balance Foot & Ankle in Southeast Michigan performs the Brostrom-Gould anatomic lateral ankle ligament reconstruction as the gold standard surgical treatment.
Why Ankle Ligaments Fail to Heal
After an acute lateral ankle sprain, many patients recover fully with RICE, early mobilization, and peroneal strengthening. However, approximately 20–40% develop chronic instability — particularly those who return to activity before the ligaments have regained sufficient mechanical strength, those with underlying hypermobility, and those who sustain multiple sprains in rapid succession. The ATFL and CFL stretch and attenuate rather than healing to their original length and stiffness, leaving a mechanically incompetent lateral restraint system. The ankle “gives way” because the ligaments can no longer prevent excessive inversion stress.
Non-Surgical Management First
Dr. Biernacki always ensures a structured non-surgical program has been properly attempted before discussing surgery. This includes peroneal strengthening exercises, proprioceptive and balance training on progressively unstable surfaces, bracing with a lace-up or semirigid ankle brace, and correction of any associated biomechanical problems (hindfoot varus, high arch cavovarus foot — which predisposes to lateral instability) with custom orthotics. If 3–6 months of this program fails to provide acceptable stability, surgery is a well-supported next step.
The Brostrom-Gould Procedure
The modified Brostrom-Gould procedure is the anatomic repair of the ATFL and CFL — the specific ligaments that were stretched and failed. Through a small incision over the lateral ankle, the attenuated ligament tissue is imbricated (overlapped and tightened) back to its original anatomic position and reinforced with the inferior extensor retinaculum (the Gould modification), which provides additional stability and proprioceptive input. The procedure preserves normal ankle anatomy — unlike older non-anatomic tenodesis procedures that used tendon grafts and often over-constrained the ankle. The Brostrom-Gould is the most widely performed and best-evidenced ankle instability procedure, with excellent long-term outcomes in appropriately selected patients.
Recovery Timeline
After Brostrom-Gould repair, patients are non-weight-bearing in a splint for 2 weeks for wound healing, then transitioned to a walking boot for 4–6 weeks with progressive weight-bearing. Physical therapy with peroneal strengthening and balance training begins at 6–8 weeks. Return to sport with a brace is typically achieved at 4–5 months post-operatively. Athletes involved in cutting, pivoting sports may require 5–6 months before full sport clearance.
Frequently Asked Questions
How do I know if I need surgery for ankle instability?
Surgery is indicated when the ankle continues to give way despite 3–6 months of dedicated rehabilitation and bracing, significantly limiting activities. A positive anterior drawer test, talar tilt stress testing, and MRI or arthrogram showing ligament attenuation confirm instability. The decision is ultimately a quality-of-life conversation — if instability is preventing activities you need or love, surgery is a reasonable and effective solution.
What is the success rate of Brostrom surgery?
The Brostrom-Gould procedure has a reported success rate of 85–97% for resolution of mechanical instability and return to sport. Long-term follow-up studies show maintained stability at 10–20 years in most patients. Results are best when the procedure is performed by an experienced foot and ankle surgeon and followed by appropriate rehabilitation.
Will my ankle be weak after Brostrom surgery?
The immediate post-operative period involves some weakness from disuse and pain guarding, but this resolves with physical therapy. The repaired ligaments are actually stronger than the attenuated ligaments that caused your instability. Most patients report significantly better ankle confidence and strength at 4–6 months than they had pre-operatively.
Can I have Brostrom surgery if I have had multiple ankle sprains?
Yes — in fact, chronic instability from multiple sprains is the primary indication for the procedure. The key consideration is whether there is adequate ligament tissue for repair (anatomic Brostrom) or whether a tendon graft (augmented reconstruction) is needed. MRI helps assess tissue quality pre-operatively. For patients with very poor tissue or failed prior Brostrom repair, augmented techniques using graft or allograft tissue are available.
If your ankle keeps giving way and conservative treatment has not helped, it may be time to consider surgical repair. Contact Balance Foot & Ankle for a consultation with Dr. Biernacki in Southeast Michigan.
Dr. Tom’s Recommended Products for Ankle Pain & Injuries
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Our board-certified podiatrists treat this condition at two convenient locations. Same-day appointments often available.
These are products I personally use and recommend to my patients at Balance Foot & Ankle.
- ASO Ankle Stabilizing Orthosis — Figure-8 straps with bilateral stability columns — the gold standard lace-up ankle brace for return to sport
- McDavid 195 Ankle Brace — Hinged design allows dorsiflexion/plantarflexion while blocking inversion — best for chronic lateral instability
- Doctor Hoy’s Natural Pain Relief Gel 3oz — Menthol-based cryotherapy — penetrates soft tissue to reduce ankle sprain inflammation and acute pain
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Dr. Tom’s Recommended: Natural Topical Pain Relief
This is what I actually use in our clinic at Balance Foot & Ankle.
- Doctor Hoy’s Natural Pain Relief Gel — Natural topical pain relief I use in our clinic. Arnica + camphor formula. Apply directly to the painful area 3-4x daily for fast-acting relief without NSAIDs.
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Top-Rated Ankle Braces
- Aircast Air-Stirrup — Gold Standard Ankle Brace
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Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.
- Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
- Heel Pain (APMA)
- Hallux Valgus (Bunions): Evaluation and Management (PubMed)
- Bunions (Mayo Clinic)