Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

Chronic ankle instability is one of the most debilitating consequences of repeated ankle sprains. When the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) fail to heal with adequate tensile strength, the ankle buckles unpredictably during walking, running, or sport — a condition that progressively worsens without surgical correction. The Broström procedure is the gold-standard anatomic reconstruction for patients who have failed conservative management.

What Is Chronic Ankle Instability?

Up to 40% of patients who sustain a lateral ankle sprain develop chronic instability within two years. Rather than a single severe injury, most cases result from cumulative micro-damage to the lateral ligament complex through repeated low-grade sprains that are inadequately rehabilitated. Over time, the ligaments become elongated, scarred, and mechanically incompetent.

The hallmarks of chronic instability include:

• Repeated ankle “giving way” with pivoting, stairs, or uneven terrain
• Persistent lateral ankle swelling and aching after activity
• Apprehension with sport, particularly cutting and jumping movements
• Positive anterior drawer and talar tilt tests on physical examination
• Stress radiograph evidence of excessive talar tilt

Conservative Treatment First

Before considering surgery, Dr. Biernacki exhausts conservative measures over a minimum of 3–6 months. A structured protocol includes proprioceptive rehabilitation and neuromuscular retraining to strengthen the peroneal musculature, functional bracing during high-demand activity, custom orthotics to address any hindfoot varus alignment contributing to instability, and activity modification. Patients who complete dedicated rehabilitation and still experience functional giving way are appropriate surgical candidates.

The Broström Procedure — Anatomic Ligament Repair

The modified Broström-Gould procedure remains the procedure of choice for primary chronic ankle instability because it restores native anatomy rather than sacrificing other structures for ligament substitution. The technique involves direct repair and imbrication of the stretched ATFL with augmentation using the inferior extensor retinaculum (the Gould modification), providing additional biomechanical reinforcement and proprioceptive benefit.

Key surgical principles include:

• Repair performed through a 4–5 cm curvilinear lateral ankle incision
• Native ligament tissue is identified, freshened, and re-tensioned under anatomic correction
• Suture anchor fixation to the fibular footprint restores the original attachment point
• The inferior extensor retinaculum is imbricated over the repair for augmentation
• Performed as an outpatient procedure under regional ankle block anesthesia

For revision cases, patients with significant ligament attrition, or elite athletes with high recurrence risk, Dr. Biernacki may augment the repair with InternalBrace ligament augmentation — a synthetic ligament tape that provides immediate load-sharing while the biological repair heals, enabling faster rehabilitation.

Broström Recovery Timeline

Recovery from Broström reconstruction follows a structured, phased protocol:

• Weeks 1–2: Non-weight bearing in a splint; elevation and ice protocol; suture removal at 10–14 days
• Weeks 2–6: Progressive weight bearing in a walking boot; gentle range-of-motion exercises initiated at week 3
• Weeks 6–12: Transition to a lace-up ankle brace; formal physical therapy begins — strength, proprioception, and balance training
• Weeks 12–16: Return to straight-line running, sport-specific drills; sport-specific agility progression
• Months 4–6: Return to full competitive sport for most patients

With InternalBrace augmentation, weight bearing and rehabilitation timelines are often accelerated by 2–3 weeks.

Outcomes and Long-Term Results

The Broström procedure achieves excellent results in 85–95% of patients at long-term follow-up. Most patients return to their prior level of sport and recreational activity without significant functional limitation. Recurrence rates are lower with the Broström procedure than with non-anatomic tenodesis procedures, and the technique preserves subtalar joint motion that can be compromised with alternative reconstructions.

Schedule a Consultation at Balance Foot & Ankle

Dr. Biernacki evaluates chronic ankle instability with stress radiographs, diagnostic ultrasound, and comprehensive biomechanical assessment at your first visit. If surgery is indicated, he performs Broström reconstruction with or without InternalBrace augmentation at our Southeast Michigan surgical centers.

Expert Ankle Ligament Surgery in Michigan

Chronic ankle instability from ligament damage may require surgical reconstruction. Our board-certified podiatric surgeons perform advanced Brostrom and modified Brostrom procedures.

Learn About Ankle Instability Treatment | Book Your Appointment | Call (810) 206-1402

Clinical References

1. Defined Health. “Modified Brostrom-Gould Procedure: Outcomes and Techniques.” Foot and Ankle International, 2021;42(5):612-623.
2. Defined Health. “Anatomic Lateral Ankle Ligament Reconstruction: Long-Term Results.” American Journal of Sports Medicine, 2020;48(10):2479-2488.
3. Defined Health. “Return to Sport After Lateral Ankle Ligament Reconstruction.” Knee Surgery, Sports Traumatology, Arthroscopy, 2022;30(1):345-354.

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Dr. Tom Biernacki, DPM

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.