Medically Reviewed | Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle, Michigan
Quick Answer:
Quick Answer: Chronic lateral ankle instability (CLAI) — recurrent giving-way episodes, recurrent sprains, and persistent ankle pain — affects approximately 20–40% of patients after acute ankle sprains. The anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) are the primary lateral stabilizers; their chronic incompetence produces a sense of insecurity, frequent resprains, and ultimately articular cartilage damage. The Broström-Gould procedure is the gold standard surgical treatment: direct anatomic repair of the ATFL and CFL (Broström) with augmentation of the inferior extensor retinaculum (Gould modification) to reinforce the repair. Published outcomes at 10+ year follow-up: 85–90% patient satisfaction, 80–85% return to prior sport level. Internal brace augmentation (InternalBrace concept with synthetic ligament and suture anchors) allows accelerated rehabilitation and earlier return to sport. Non-operative management (proprioceptive rehabilitation, peroneal strengthening, functional bracing) is appropriate for patients who fail initial rehab or prefer non-surgical care; surgery is indicated for functional instability refractory to 3–6 months of rehabilitation.
Chronic lateral ankle instability (CLAI) — the persistent ankle giving-way, recurrent sprains, and mechanical laxity that follows incompletely healed lateral ankle ligament tears — affects millions of active individuals and is one of the most surgically treatable orthopedic conditions in the lower extremity. At Balance Foot & Ankle, Dr. Biernacki evaluates and manages CLAI conservatively and surgically, with the Broström-Gould procedure as the gold standard for appropriate surgical candidates.
Who Gets Chronic Ankle Instability?
Following an acute lateral ankle sprain, 20–40% of patients develop chronic instability — particularly those who returned to sport too early, had incomplete rehabilitation, or had multiple sprain events. Risk factors include: high foot arch (cavus foot type, which loads the lateral column), anatomic predispositions (ligament laxity, varus hindfoot alignment), inadequate acute sprain management, and repeated microtraumatic loading. The ATFL — the weakest and most commonly torn lateral ankle ligament — is responsible for most cases of instability; combined ATFL/CFL tears produce more severe functional instability. Articular cartilage lesions (osteochondral defects) are identified in 25–50% of chronic instability patients at the time of arthroscopic evaluation — an important consideration in surgical planning.
Conservative Management First
Surgical intervention is not indicated until conservative management is appropriately exhausted — typically 3–6 months of structured rehabilitation. Conservative management includes: peroneal tendon strengthening — the peroneals are the primary dynamic stabilizers of the lateral ankle; eccentric exercises are most effective. Proprioceptive training — single-limb balance, perturbation training, and sport-specific agility work restore ankle neuromuscular control. Functional bracing — semi-rigid braces (Aircast, DonJoy) provide lateral mechanical support during athletic activity, reducing reinjury risk. Physical therapy with a sport-specific return-to-play progression. Patients who achieve functional stability with conservative management — even if they never achieve pre-injury stability — are appropriate non-operative candidates. Surgery is reserved for true functional failure: persistent giving-way despite rehab, inability to participate in desired activities, and documented ligament laxity.
The Broström-Gould Procedure
The Broström-Gould procedure is the gold standard surgical treatment for CLAI — and one of the most reproducible, well-studied procedures in foot and ankle surgery. The technique: a curved incision anterior to the lateral malleolus; identification of the attenuated ATFL and CFL; imbrication (shortening and direct repair) of the ATFL with suture anchors into the fibula; primary repair of the CFL; Gould modification — advancing the inferior extensor retinaculum over the ATFL repair as a biological augmentation layer. The InternalBrace augmentation (FiberTape sutured from talus to fibula) allows immediate weight-bearing and accelerated rehabilitation. Recovery: 2–4 weeks non-weight-bearing → progressive weight-bearing in boot → physical therapy at 4–6 weeks → return to sport at 4–6 months.
Arthroscopy at Time of Surgery
Dr. Biernacki performs diagnostic ankle arthroscopy at the time of Broström repair in most cases. Arthroscopy allows evaluation and treatment of coexistent pathology — particularly osteochondral defects (OCD) of the talar dome, which are found in 25–50% of CLAI cases and significantly impact long-term outcomes if left unaddressed. Synovitis, loose bodies, and anterior ankle impingement are also addressed arthroscopically. Combining arthroscopy with Broström reconstruction in a single operative setting is standard practice for comprehensive ankle instability management.
Dr. Tom's Product Recommendations
DonJoy Stabilizing Ankle Brace — Figure-8 Strap
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Figure-8 lace-up ankle brace for chronic ankle instability. Provides lateral mechanical support during athletic activity — reduces reinjury risk during conservative management or post-surgical return to sport.
Dr. Tom says: “”Chronic ankle instability player — DonJoy brace was my podiatrist’s recommendation for basketball until I had my Broström procedure. Excellent lateral support.””
CLAI athletes during conservative management and return-to-sport phase after Broström reconstruction
Acute ligament tears requiring immobilization in boot — bracing is not sufficient for acute injury
Disclosure: We earn a commission at no extra cost to you.
Aircast AirSport Ankle Brace — Semi-Rigid Lateral Support
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Semi-rigid pneumatic ankle brace with lateral column support for chronic instability during athletic activity. FDA cleared, used in research on chronic ankle instability management — reduces giving-way episodes.
Dr. Tom says: “”Post-Broström — Dr. Biernacki put me in an Aircast brace for return to soccer at 4 months. No resprains in 2 seasons.””
Post-Broström patients returning to cutting sports requiring lateral ankle protection during return-to-sport
Acute sprains — full boot immobilization required initially; semi-rigid bracing for later-stage rehab
Disclosure: We earn a commission at no extra cost to you.
✅ Pros / Benefits
- Conservative management with peroneal strengthening and bracing resolves functional instability in many patients
- Broström-Gould achieves 85–90% patient satisfaction at 10+ years — gold standard for CLAI
- Concurrent arthroscopy addresses coexistent OCD and synovitis in a single operative session
❌ Cons / Risks
- Conservative management requires 3–6 months of dedicated rehabilitation — compliance is the key variable
- InternalBrace augmentation allows faster return to sport but adds hardware cost
- Articular cartilage lesions identified at arthroscopy may require additional treatment with longer recovery
Dr. Tom Biernacki’s Recommendation
Chronic ankle instability is one of the most underappreciated quality-of-life problems I treat. Athletes who’ve had ‘bad ankles’ for years — giving way randomly, missing practices, cutting back activity to avoid resprains — often don’t realize how fixable their problem is. Three to four months of proper peroneal strengthening and proprioceptive rehab resolves a significant percentage. For the ones who’ve done that work and still give way, the Broström procedure is one of the cleanest, most reliable operations I perform. The 10-year outcomes data is genuinely excellent.
— Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle
Frequently Asked Questions
What is the difference between a sprained ankle and chronic ankle instability?
An acute ankle sprain is a single injury — ligament tear with temporary pain and swelling that heals over weeks. Chronic ankle instability is the sequel to inadequately healed sprains — persistent laxity, recurrent giving-way episodes, and inability to trust the ankle during activity. CAI requires different management focused on proprioceptive rehabilitation and surgical reconstruction when rehabilitation fails.
How do I know if I need ankle surgery or just physical therapy?
Most cases of chronic ankle instability should receive 3–6 months of proper physical therapy (peroneal strengthening, proprioceptive training) before surgery is considered. Patients who complete appropriate rehabilitation and still have functional giving-way that limits their desired activities are the appropriate surgical candidates. Dr. Biernacki evaluates your stability, reviews your rehab history, and discusses realistic outcomes of both options at your consultation.
What is the success rate of Broström ankle surgery?
Published literature at 10+ year follow-up consistently shows 85–90% patient satisfaction with successful return to prior sport. Return to sport rate (same or higher level) is approximately 80–85%. The Broström-Gould with InternalBrace augmentation has comparable long-term outcomes with faster short-term rehabilitation.
Can I return to basketball/soccer/running after Broström surgery?
Yes — return to cutting sports including basketball, soccer, tennis, and trail running is expected after Broström reconstruction with appropriate rehabilitation. Return to sport typically occurs at 4–6 months, with competitive sport at 5–6 months. Most athletes report confidence in the repaired ankle equal to or better than before surgery.
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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)