What Is Chronic Ankle Instability?

Chronic ankle instability (CAI) develops when the lateral ankle ligaments — most commonly the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL) — fail to heal adequately after one or more ankle sprains. The result is a mechanically unstable ankle that “gives way” during walking, running, or sports, with recurrent sprains occurring on progressively less traumatic mechanisms.

Studies suggest that up to 40% of acute ankle sprains lead to some degree of chronic instability. Risk factors include incomplete rehabilitation after the initial sprain, returning to activity before ligament healing is complete, and anatomical factors such as hindfoot varus alignment. CAI not only impacts athletic performance and daily function but also accelerates ankle cartilage degeneration — making early, definitive treatment important.

When Is Surgery Needed?

Most cases of chronic ankle instability respond to functional rehabilitation — specifically, peroneal strengthening, proprioceptive training, and ankle bracing. When conservative treatment fails to provide adequate stability after 3–6 months of dedicated rehabilitation, surgical intervention is considered. Surgery is also appropriate for patients with mechanical instability (demonstrably lax ligaments on stress X-rays or under examination) that has not responded to bracing, and for high-demand athletes who cannot achieve the stability required for their sport through non-surgical means.

The Broström Procedure

The Broström procedure, developed by Swedish surgeon Gösta Broström in the 1960s, is the gold standard surgical treatment for chronic lateral ankle instability. The procedure involves surgically shortening and directly re-attaching the stretched or torn ATFL and CFL to their anatomical attachment sites on the fibula, restoring the natural tension and mechanical restraint these ligaments provide.

The modified Broström procedure — popularized by Gould, Inglis, and Trevino — augments the primary repair with the inferior extensor retinaculum, a tough fibrous band on the anterior ankle, which reinforces the reconstruction and provides additional stability particularly against inversion forces. This modification has become the standard approach used by most foot and ankle surgeons today.

Surgical Technique

The procedure is performed under regional anesthesia (ankle block) with or without sedation in an outpatient setting. An incision approximately 3–5 cm long is made over the lateral ankle, centered over the fibular tip. The ATFL is identified — it typically appears attenuated (thin and stretched out) or frankly torn. The ligament is shortened by imbrication (folding and suturing on itself) and re-attached to the fibula either with sutures alone or using small bone anchors. The inferior extensor retinaculum is then sutured to the repair for augmentation.

Arthroscopic-assisted and fully arthroscopic Broström techniques have been developed that achieve the same repair through smaller incisions with potentially faster recovery, though open techniques remain widely used and effective.

Who Is a Good Candidate?

The ideal candidate for the Broström procedure is a patient with documented mechanical ankle instability, adequate ligament tissue for direct repair (not completely absent or severely degenerated), and normal or near-normal body weight. The procedure consistently produces excellent outcomes in athletes and active individuals under 250 pounds with isolated lateral ankle instability.

Patients with generalized ligamentous laxity (hypermobility syndrome), significant obesity, revision surgery (prior failed Broström), or severe ligament deficiency may require augmentation with a tendon graft (such as the peroneus brevis tendon) — procedures generally called “anatomic reconstruction with augmentation” or, historically, “Chrisman-Snook” procedures. These are used less frequently than the Broström but are appropriate in selected cases.

Recovery Timeline

Recovery from a Broström procedure is well-defined and predictable for most patients:

• Week 1–2: Non-weight-bearing in a splint; keep foot elevated; wound care
• Week 2–6: Progressive weight-bearing in a cast or walking boot
• Week 6–12: Transition to lace-up ankle brace; begin formal physical therapy for range of motion and strengthening
• Month 3–4: Return to straight-line jogging; continued proprioceptive training
• Month 4–6: Return to cutting, pivoting, and sport-specific activities
• 6 months: Typical return to full competitive sport with ankle brace

Outcomes and Long-Term Results

The Broström procedure has an excellent long-term track record. Published literature consistently demonstrates good-to-excellent results in 85–95% of patients with return to sport and resolution of instability complaints. Long-term follow-up studies at 10–20 years continue to show durable results, with maintained stability and ankle function in the majority of patients. The anatomic nature of the repair — restoring the ligaments to their normal positions rather than creating mechanical blocks — preserves natural ankle joint kinematics and is associated with lower rates of secondary ankle arthritis compared to older non-anatomic reconstruction techniques.

Is the Broström Right for You?

If you have a history of recurrent ankle sprains, your ankle gives way during normal activities or sport, or bracing has not provided adequate stability, a consultation with a foot and ankle specialist is the appropriate next step. At Balance Foot & Ankle, we perform a thorough stability assessment and review imaging before discussing surgical and non-surgical options. The goal is to restore an ankle that you can trust — for your sport, your work, and your daily life.

Foot or Ankle Pain? We Can Help.

Balance Foot & Ankle — Howell & Bloomfield Township, MI

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Your Board-Certified Podiatrists

Dr. Tom Biernacki, DPM

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Dr. Carl Jay, DPM

Board-Certified Podiatrist

Dr. Daria Gutkin, DPM

Podiatrist

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.