Medically Reviewed | Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle, Michigan
Quick Answer:
Quick Answer: Chronic ankle sprains — three or more ankle sprains, or persistent instability after a single severe sprain — indicate lateral ligament laxity that doesn’t resolve with rest alone. Dr. Biernacki evaluates ankle stability with stress testing and weight-bearing X-rays, and when MRI confirms significant ligament damage, provides targeted treatment: aggressive rehabilitation and bracing for functional instability, or Broström-Gould lateral ligament reconstruction for structural instability that fails conservative management.
Why Some Ankles Keep Spraining
A single ankle sprain stretches or tears the lateral ligaments — most commonly the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL). Most first-time sprains heal with proper rehabilitation. But when sprains recur repeatedly, or when the ankle feels unstable and unpredictable on uneven ground, the ligaments have been stretched beyond their ability to provide mechanical stability. This is chronic lateral ankle instability — a structural problem that requires targeted treatment, not just more rest.
Functional vs. Structural Instability
Dr. Biernacki distinguishes two types of chronic ankle instability. Functional instability exists when ligament integrity is preserved but neuromuscular control — the peroneal muscles’ ability to react quickly to ankle perturbation — is impaired. This responds well to proprioceptive physical therapy, peroneal strengthening, and ankle bracing. Structural instability means the ligaments themselves are lax and cannot provide adequate mechanical restraint. This type requires surgical reconstruction to restore normal ankle mechanics.
Diagnostic Evaluation: Stress Tests and Imaging
Diagnosis includes anterior drawer test (assessing ATFL laxity), talar tilt test (CFL laxity), and bilateral comparison weight-bearing X-rays. MRI is ordered when the clinical picture suggests significant ligament damage, osteochondral defects, or peroneal tendon involvement — all common concurrent findings in recurrent sprains. The imaging guides surgical planning when reconstruction is indicated.
The Broström-Gould Procedure
For structural instability, Dr. Biernacki performs the modified Broström-Gould lateral ankle reconstruction — the gold standard for lateral ligament repair. The procedure tightens and reinforces the stretched ATFL and CFL using the superior extensor retinaculum for additional reinforcement. It’s performed as an outpatient procedure under regional anesthesia. Recovery involves non-weight-bearing for 2 weeks, then a boot for 4 weeks, then physical therapy for 8–12 weeks. Return to sport is typically at 4–6 months with an excellent long-term success rate above 90%.
Dr. Tom's Product Recommendations
ASO Ankle Stabilizing Orthosis
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Lace-up ankle brace with bilateral stabilizing straps. The most commonly prescribed athletic ankle brace for chronic ankle instability — fits inside most athletic shoes. Dr. Biernacki’s top brace recommendation for functional ankle instability.
Dr. Tom says: “Wore this all soccer season after three sprains. Dr. Biernacki recommended the ASO and I had zero re-sprains the entire season.”
Chronic ankle instability, recurrent sprains, return to sport after sprain
Structural instability confirmed on MRI — requires surgical evaluation
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BOSU Balance Trainer
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Balance and proprioception training platform for ankle rehabilitation. Essential tool in Dr. Biernacki’s home rehab protocol for functional ankle instability — rebuilds peroneal reaction speed.
Dr. Tom says: “Dr. Biernacki gave me specific single-leg balance exercises on a BOSU as part of my ankle rehab. My ankle stability improved dramatically in 8 weeks.”
Ankle proprioception rehab, peroneal strengthening, functional instability treatment
Acute sprain phase (wait until cleared for balance training)
Disclosure: We earn a commission at no extra cost to you.
✅ Pros / Benefits
- Stress testing and MRI evaluation identifies functional vs. structural instability
- Broström-Gould reconstruction with >90% long-term success rate
- Conservative-first: bracing and PT before surgical consideration
- Returns athletes to full sport activity at 4–6 months post-reconstruction
❌ Cons / Risks
- Surgical reconstruction requires 4–6 months before return to cutting sports
- Concurrent osteochondral defects may complicate recovery and require additional treatment
Dr. Tom Biernacki’s Recommendation
Chronic ankle instability is one of the most common things I operate on — and also one of the most preventable with early proper rehabilitation. The patients who end up needing surgery are almost always those who didn’t do adequate rehab after their first sprain.
— Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle
Frequently Asked Questions
How many sprains is ‘too many’ before I should see a doctor?
Ideally, you’d see a podiatrist after the first significant sprain to ensure proper ligament healing and rehab. Practically, three or more sprains — or any sprain where the ankle feels unstable between sprains — warrants evaluation.
Can I play sports with a brace instead of getting surgery?
Many patients with functional instability do well long-term with bracing and strength training. For structural instability on MRI, bracing is a long-term accommodation but doesn’t fix the underlying ligament laxity.
What does Broström-Gould surgery recovery involve?
2 weeks non-weight-bearing, then 4 weeks in a boot, then 8–12 weeks of physical therapy. Return to running at ~12 weeks and full sport at 4–6 months.
Do I need an MRI before surgery?
Yes — MRI is standard before reconstruction to confirm ligament status, rule out osteochondral defects, and assess peroneal tendon integrity. It’s always done before surgical planning.
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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)
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