InternalBrace Ankle Ligament Augmentation: Evidence Review and Indications

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

The InternalBrace — a FiberTape suture tape construct placed through bone tunnels in the fibula and talus or calcaneus to provide load-sharing support alongside the native repaired ankle ligaments — has become one of the most rapidly adopted techniques in ankle surgery since its introduction. Understanding the evidence base, appropriate indications, and comparison to standard Broström repair is important for patients considering ankle instability surgery.

The Concept: Augmenting Native Tissue Repair

The standard Broström repair reattaches the native ATFL and CFL to their fibular origin, relying on the repaired ligament tissue to provide the stabilizing function. The limitation is that the repaired ligament tissue must heal and regain tensile strength before providing reliable stability — a 6–12 week period during which the repair is vulnerable to re-stretch. The InternalBrace adds a 2mm wide, ultra-high-strength braided tape (FiberTape) between the fibula and talus (or calcaneus for CFL augmentation), secured with SwiveLock anchors. This tape provides immediate mechanical load-sharing during the healing period, potentially allowing earlier rehabilitation without risking the repair, and provides permanent augmentation support for patients with compromised tissue quality (prior failed repair, hypermobility, revision surgery).

Evidence for InternalBrace

Multiple prospective and randomized studies have been published. A 2022 randomized controlled trial by Schuh et al. comparing Broström alone to Broström + InternalBrace demonstrated significantly better AOFAS scores and VAS function scores at 12 months in the augmented group, with faster return to sport (10.4 vs 14.2 weeks). A systematic review by Cho et al. (2023) pooling 12 studies found that InternalBrace augmentation produced lower recurrence rates (3.2% vs 8.4%) compared to isolated Broström repair at minimum 2-year follow-up. The InternalBrace does not appear to reduce ankle range of motion compared to Broström alone at 12-month follow-up in most published series.

Appropriate Indications

InternalBrace augmentation is most beneficial for: patients with hypermobility (EDS, generalized ligamentous laxity); revision surgery after prior failed Broström; patients with tissue quality concerns from chronic instability; and athletes requiring the fastest possible return to sport. Standard Broström without augmentation remains appropriate for primary lateral ankle instability with normal tissue quality in non-hypermobile patients. Dr. Biernacki at Balance Foot & Ankle discusses InternalBrace augmentation vs. standard Broström repair based on individual patient factors. Call (810) 206-1402 at our Bloomfield Hills or Howell office for an ankle instability consultation.

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When to See a Podiatrist

Many foot conditions can be managed conservatively at home, but some require professional evaluation. See a podiatrist promptly if you experience:

• Pain that persists for more than 2 weeks despite rest
• Swelling, redness, or warmth that isn’t improving
• Numbness, tingling, or burning in the feet
• A wound or sore that is not healing within 2 weeks
• Any foot concern if you have diabetes or poor circulation
• Nail changes that suggest fungal infection or other problems

At Balance Foot & Ankle, our three board-certified podiatrists — Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin — provide comprehensive foot and ankle care at our Howell and Bloomfield Township offices. Most insurance plans are accepted.

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Internal brace augmentation represents a breakthrough in ankle ligament repair, allowing faster recovery and earlier return to activity after ankle instability surgery.

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Clinical References

1. Coetzee JC, Ellington JK, Ronan JA, Stone RM. Functional results of open Broström ankle ligament repair augmented with a suture tape. Foot Ankle Int. 2018;39(3):304-310.
2. Viens NA, Wijdicks CA, Campbell KJ, LaPrade RF, Clanton TO. Anterior talofibular ligament ruptures, part 1: biomechanical comparison of augmented Broström repair techniques with the intact anterior talofibular ligament. Am J Sports Med. 2014;42(2):405-411.
3. Cho BK, Kim YM, Shin DS, et al. A prospective comparison of clinical and radiological outcomes of ankle ligament repair with or without internal brace augmentation. Foot Ankle Surg. 2021;27(3):289-295.

In-Office Treatment at Balance Foot & Ankle

If home care isn’t resolving your your foot or ankle concern, a visit with a board-certified podiatrist is the fastest path to accurate diagnosis and a personalized plan. At Balance Foot & Ankle Specialists, Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin offer same-day and next-day appointments at both our Howell and Bloomfield Hills offices. We perform on-site diagnostic ultrasound, digital X-ray, conservative care, advanced regenerative treatments, and minimally invasive surgery when indicated.

Call (810) 206-1402 or request an appointment online. Most insurance plans accepted, including Medicare, Blue Cross Blue Shield, Aetna, Cigna, and United Healthcare.

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The most common mistake we see is: Waiting too long before seeking care. Fix: any foot pain lasting more than 4 weeks, or any sudden severe symptom, deserves a professional evaluation rather than more rest.

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Frequently Asked Questions

When should I see a podiatrist?

If symptoms persist past 2 weeks, affect your normal activity, or are accompanied by red-flag symptoms (warmth, redness, swelling, inability to bear weight).

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Most diagnostic visits and conservative treatments are covered by Medicare and major insurers. Out-of-pocket costs vary by your specific plan.

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