Same-Week Appointments at Balance Foot & Ankle
Three board-certified podiatric surgeons. 950K+ YouTube subscribers. 1,123+ five-star reviews. Howell & Bloomfield Hills, Michigan.
Medically Reviewed | Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle, Michigan
Quick Answer: Why do I keep spraining my ankle over and over?
The Vicious Cycle of Repeated Ankle Sprains
A single ankle sprain doesn’t cause chronic ankle instability—but a single poorly rehabilitated ankle sprain frequently does. The natural history of ankle sprains explains why: the initial sprain damages the ATFL and sometimes CFL ligaments and, critically, damages the mechanoreceptors (proprioceptive sensory organs) within those ligaments. These mechanoreceptors are essential for the rapid neuromuscular reflexes that protect the ankle from giving way.
When a sprained ankle is treated with RICE alone (rest, ice, compression, elevation) and returned to activity as soon as pain allows—without specific rehabilitation of proprioception, peroneal strength, and movement control—the joint becomes vulnerable to reinjury. The proprioceptive deficit (reduced ankle position sense) means the peroneal muscles can’t activate fast enough to prevent the ankle from inverting when the ground suddenly shifts. This deficit can persist for months to years after an incompletely rehabilitated sprain.
The consequence: with each subsequent sprain, the ligaments stretch further and the proprioceptive deficit worsens. Chronic ankle instability develops—characterized by recurrent sprains, persistent feelings of giving way, and eventual mechanical laxity from cumulative ligament stretching.
Diagnosing the Specific Cause of Your Repeated Sprains
Proprioceptive deficit: single-leg balance testing reveals meaningful asymmetry (inability to balance on the affected ankle for 30 seconds compared to the unaffected side). Star Excursion Balance Test (SEBT) quantifies proprioceptive deficits objectively. Proprioceptive deficit is the most common cause of functional ankle instability.
Peroneal muscle weakness: manual muscle testing and isokinetic strength testing reveal peroneal eversion strength deficits of 15–30% compared to the unaffected side in most CAI patients. Peroneal weakness means the primary protective reflex against ankle inversion is inadequate.
Structural mechanical laxity: stress radiographs (anterior drawer and talar tilt stress X-rays) quantify ligament laxity. Talar tilt >10° or anterior drawer >5mm indicates true mechanical laxity. MRI confirms ATFL and CFL integrity. Patients with mechanical laxity that fails neuromuscular rehabilitation may be surgical candidates.
Other contributing factors: subtalar instability (often overlooked—the subtalar joint can be independently lax after ankle sprains); peroneal tendon subluxation or tears (co-existing pathology that requires independent treatment); and sinus tarsi syndrome (posterior residual inflammation from the original sprain).
Breaking the Sprain Cycle: What Actually Works
The evidence is unambiguous: structured neuromuscular rehabilitation is the most effective intervention for preventing ankle sprain recurrence. Key components: proprioceptive balance training (single-leg balance, wobble board, BOSU ball progression); peroneal strengthening (resistance band eversion progression); and functional sports-specific movement training. Programs of 6–8 weeks reduce reinjury risk by 35–50% in athletes with chronic ankle instability.
Ankle bracing during high-risk activities: semi-rigid lace-up braces (Active Ankle, Swede-O) significantly reduce ankle sprain recurrence in athletes—by approximately 50% in randomized trials among athletes with prior sprain history. Bracing does not cause weakness when combined with strengthening; it provides external support during sport while rehabilitation builds internal stability.
If rehabilitation and bracing fail: surgical Brostrom-Gould ligament reconstruction for documented mechanical instability; peroneal tendon exploration for tear or subluxation; sinus tarsi injection or debridement for persisting sinus tarsi syndrome. Surgery should be specifically targeted at the identified pathology rather than performed empirically.
Dr. Tom's Product Recommendations
PowerStep Pinnacle Insoles
⭐ Highly Rated | Foundation Wellness Partner | 30% Commission
Arch support that controls subtalar pronation—one of the mechanical contributors to ankle valgus stress and sprain risk. Use during rehabilitation and return to sport.
Dr. Tom says: “https://ws-na.amazon-adsystem.com/widgets/q?_encoding=UTF8&ASIN=B00HFMJRB0&Format=_SL250_&ID=AsinImage&MarketPlace=US&ServiceVersion=20070822&WS=1&tag=biernact-20”
PowerStep
⭐⭐⭐⭐⭐
Disclosure: We earn a commission at no extra cost to you.
Doctor Hoy’s Natural Pain Relief Gel
⭐ Highly Rated | Foundation Wellness Partner | 30% Commission
Post-training recovery for chronic ankle instability rehabilitation soreness. Natural anti-inflammatory ingredients manage the cumulative soreness from intensive proprioceptive training.
Dr. Tom says: “https://ws-na.amazon-adsystem.com/widgets/q?_encoding=UTF8&ASIN=B00BVYVSRY&Format=_SL250_&ID=AsinImage&MarketPlace=US&ServiceVersion=20070822&WS=1&tag=biernact-20”
Doctor Hoy’s
⭐⭐⭐⭐½
Disclosure: We earn a commission at no extra cost to you.
✅ Pros / Benefits
- Structured rehabilitation breaks the sprain cycle with 35-50% reinjury risk reduction
❌ Cons / Risks
- Most people don’t get adequate rehabilitation after the first sprain—the cycle starts immediately
Dr. Tom Biernacki’s Recommendation
Repeated ankle sprains are almost always a rehabilitation failure, not bad luck. The first sprain damages proprioception; without proper rehab to rebuild it, the ankle can’t protect itself. I tell every ankle sprain patient: the RICE phase is just the first week. The next 6 weeks of proprioceptive and peroneal strengthening is what prevents the second sprain. Skip that phase and you’re starting a cycle that often ends in a Brostrom reconstruction.
— Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle
Frequently Asked Questions
How many times spraining your ankle is too many?
There’s no specific number—the important factor is whether rehabilitation was completed after each sprain. Recurrent sprains with completed rehabilitation suggest true mechanical laxity; recurrent sprains without rehabilitation suggest neuromuscular deficit that can be treated.
Does ankle taping prevent reinjury?
Semi-rigid lace-up bracing reduces reinjury risk by approximately 50% in athletes with prior sprains. Prophylactic taping also provides meaningful protection, though it loses effectiveness as the tape stretches during activity.
Can weak ankles be fixed without surgery?
Yes—for functional instability (normal mechanical laxity with neuromuscular deficit), 6-8 weeks of proprioceptive and peroneal strengthening produces major improvement and breaks the reinjury cycle for most patients.
Michigan Foot Pain? See Dr. Biernacki In Person
4.9★ rated | 1,123 Reviews | 3,000+ Surgeries
Same-week appointments · Howell & Bloomfield Hills
📞 (810) 206-1402 Book Online →When Shoes Aren’t Enough — Dr. Tom’s Top 9 Orthotics
About 30% of patients I see for foot pain need MORE than a great shoe — they need a structured insole. Below: my complete 2026 orthotic ranking with pros, cons, and the specific patient I’d give each one to.
★ DR. TOM’S COMPLETE 2026 ORTHOTIC RANKING
9 Best Prefab Orthotics by Use Case
PowerStep, Currex, Spenco, Vionic, and PowerStep Pinnacle — every orthotic I’ve fitted to thousands of patients across both Michigan offices. Each card includes pros, cons, and the specific patient I’d give it to. Real Amazon ratings, review counts, and prices below.
Best All-Purpose Orthotic for Most Patients
Semi-rigid arch shell + dual-layer cushion + deep heel cup. The orthotic I’ve fitted to more patients than any other for 15 years. APMA-accepted. Trim-to-fit design works in athletic shoes, casual shoes, and most work boots.
✓ Pros
- Semi-rigid arch shell provides true biomechanical correction
- Deep heel cup centers the heel and reduces lateral instability
- Dual-layer cushion (top + bottom) lasts 9-12 months daily wear
- Available in 8 sizes for precise fit
- APMA-accepted and clinically validated
- Lower price than PowerStep Pinnacle for equivalent function
✗ Cons
- Too thick for most dress shoes (use ProTech Slim instead)
- Some break-in period required (3-7 days for arch tolerance)
- Not enough correction for severe pes planus or rigid pes cavus
Dr. Tom’s Recommendation: If a patient has run-of-the-mill plantar fasciitis, mild flat feet, or arch fatigue, this is the first orthotic I try. Better value than PowerStep Pinnacle for 90% of patients, which is why I swapped it into our clinic kits three years ago. Sub-$50 typically.
Maximum Motion Control · Flat Feet & Severe Over-Pronation
PowerStep’s most aggressive stability orthotic. Adds a 2°-7° medial heel post on top of the standard PowerStep platform — designed specifically for flat-footed patients and severe pronators who need real corrective force.
✓ Pros
- 2°-7° medial heel post adds aggressive pronation control
- Same trusted PowerStep arch shell, more correction
- Built specifically for flat-foot biomechanics
- Excellent for posterior tibial tendon dysfunction (PTTD)
- Removable top cover for cleaning
✗ Cons
- Too aggressive for neutral-arch patients
- Needs longer break-in (10-14 days) due to stronger correction
- Adds 2-3 mm of stack height — won’t fit slim dress shoes
Dr. Tom’s Recommendation: When a patient comes in with significant flat feet AND symptoms (heel pain, arch pain, knee pain), the Original PowerStep isn’t aggressive enough. The Maxx is what gets prescribed. About 25% of my flat-footed patients end up here.
Low-Profile · Fits Dress Shoes & Narrow Casuals
3 mm slim profile with podiatrist-designed tri-planar arch technology. Engineered specifically to fit inside dress shoes, oxfords, loafers, and women’s flats without crowding the toe box. Vionic was founded by an Australian podiatrist.
✓ Pros
- 3 mm slim profile (vs 7-10 mm for standard orthotics)
- Tri-planar arch technology adds support without bulk
- Built-in deep heel cup despite slim design
- Fits dress shoes WITHOUT having to remove the factory insole
- Trim-to-fit · APMA-accepted
✗ Cons
- Less arch support than full-volume orthotics
- Top cover wears faster than thicker alternatives
- Not enough correction for severe foot deformities
Dr. Tom’s Recommendation: My default when a patient says ‘I need orthotics but I have to wear dress shoes for work.’ Slim enough to fit in oxfords and pumps without the heel sliding out. The single highest-impact change you can make for office workers with foot pain.
Built-In Metatarsal Pad · Morton’s Neuroma · Ball-of-Foot Pain
Standard Pinnacle orthotic with a built-in metatarsal pad positioned proximal to the metatarsal heads — the exact location that offloads neuromas and metatarsalgia. No need for separate met pads or pad placement guesswork.
✓ Pros
- Built-in met pad eliminates DIY pad placement errors
- Specifically designed for Morton’s neuroma + metatarsalgia
- Same trusted PowerStep arch + heel cup platform
- Top cover protects sensitive forefoot skin
- Faster relief than orthotics + add-on met pads
✗ Cons
- Met pad position is fixed (can’t fine-tune individual placement)
- Some patients with very small or very large feet need custom
- Slightly thicker than the standard Pinnacle
Dr. Tom’s Recommendation: If a patient has Morton’s neuroma, sesamoiditis, or generalized ball-of-foot pain (metatarsalgia), this saves a clinic visit and a prescription. The built-in pad placement is anatomically correct for 80% of feet. Way better than DIY met pads.
Adaptive Dynamic Arch · Athletic & Daily Wear
Currex’s flagship adaptive arch technology — the orthotic flexes with your gait instead of fighting it. Different stiffness zones along the length give you targeted support at the heel, midfoot, and forefoot. Available in three arch heights (low/medium/high).
✓ Pros
- Dynamic flex zones adapt to natural gait cycle
- Three arch heights ensure precise fit
- Lighter than rigid orthotics (no ‘heavy foot’ feel)
- Excellent for runners and athletic walkers
- European podiatric design (German engineering)
✗ Cons
- More expensive than PowerStep Original ($55-65 typically)
- Less aggressive correction than Pinnacle Maxx for severe cases
- Three arch heights means you must self-select correctly
Dr. Tom’s Recommendation: I started recommending Currex three years ago for runners who said PowerStep felt ‘too rigid.’ The dynamic flex zones respect natural gait. Best for active patients who walk 8K+ steps daily and don’t need maximum motion control.
Running-Specific · Heel Strike + Forefoot Strike Compatible
Currex’s purpose-built running orthotic. The midfoot flex zone is positioned for runner’s gait mechanics, with a flared heel cushion for heel strikers and a forefoot rocker for midfoot/forefoot strikers. Tested on 1000+ runners during product development.
✓ Pros
- Designed by German biomechanics lab specifically for runners
- Dynamic arch flexes with running gait (not static like PowerStep)
- Three arch heights (low/medium/high)
- Reduces overuse injury risk in mid-distance runners
- Lightweight (no impact on cadence)
✗ Cons
- Premium price ($60-75)
- Not aggressive enough for severe over-pronators (use Pinnacle Maxx)
- Runner-specific design = less ideal for daily walking shoes
Dr. Tom’s Recommendation: If a patient runs 20+ miles per week and has plantar fasciitis or shin splints, this is the orthotic I prescribe. The dynamic flex zones respect running biomechanics in a way that no rigid PowerStep can match. Pricier but worth it for serious runners.
Cavus Foot & High-Arch Patients
Polyurethane base with a deeper heel cup and higher arch profile than PowerStep — built for cavus (high-arched) feet that need maximum cushion and support. The 5-zone cushioning system addresses the unique pressure points of high-arch feet.
✓ Pros
- Deeper heel cup centers the heel for cavus foot stability
- Higher arch profile fills the void under high arches
- 5-zone cushioning addresses cavus foot pressure points
- Polyurethane base lasts 12+ months
- Available in Wide width
✗ Cons
- Too tall/aggressive for normal or low arches
- Won’t fit slim dress shoes
- Pricier than PowerStep Original
- Some patients find the arch height uncomfortable initially
Dr. Tom’s Recommendation: Cavus foot patients are often misdiagnosed and given low-arch orthotics — that makes everything worse. Spenco’s Total Support has the arch profile that high-arch feet actually need. About 15% of my patients have cavus feet; this is what they wear.
Cushion Layer · Standing All Day · Gel Pressure Relief
NOT a true biomechanical orthotic — this is a cushion insole. But for patients who want gel pressure relief instead of arch correction (or to add ON TOP of factory insoles in work boots), this is the best gel option on Amazon.
✓ Pros
- Genuine gel cushioning (not foam pretending to be gel)
- Targeted gel waves under heel and ball of foot
- Trim-to-fit · works in most shoe types
- Sub-$15 price (most affordable option in this list)
- Massaging texture is genuinely soothing
✗ Cons
- ZERO arch support — this is cushion only
- Won’t fix plantar fasciitis or flat-foot issues
- Compresses faster than PowerStep (4-6 months)
- Top cover wears through in high-mileage applications
Dr. Tom’s Recommendation: I recommend these to patients who tell me ‘I just want my feet to stop hurting at the end of my shift’ and who don’t have a biomechanical issue. Construction workers, factory workers, retail. Pure cushion does the job for them.
Tight-Fitting Shoes · Cycling Shoes · Hockey Skates
PowerStep Pinnacle’s slim version of their famous Green insole. The trademark stabilizer cap is preserved but the overall thickness is reduced — works in cycling shoes, hockey skates, ski boots, and other tight-fitting footwear that the standard PowerStep Pinnacle can’t fit into.
✓ Pros
- Stabilizer cap centers the heel (PowerStep Pinnacle’s signature feature)
- Slim profile fits tight athletic footwear
- Lasts 12+ months daily wear
- Excellent for cycling shoes specifically
- Built-in odor-control treatment
✗ Cons
- Premium price ($45-55)
- Less cushion than PowerStep equivalents
- Not as aggressive correction as Pinnacle Maxx for flat feet
- The signature ‘heel cup feel’ takes 1-2 weeks to adapt to
Dr. Tom’s Recommendation: If you’re a cyclist with foot numbness, hot spots, or knee pain — this is the orthotic. The stabilizer cap solves cycling-specific biomechanical issues that no other orthotic addresses. Worth the premium for athletes.
None of these solving your foot pain?
Some patients (about 30%) need custom-molded prescription orthotics. We make 3D-scanned custom orthotics in our Howell and Bloomfield Hills offices — specifically built for your foot mechanics.
Schedule a Custom Orthotic Fitting →FSA/HSA eligible · Most insurance accepted · (810) 206-1402
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.
- Plantar Fasciitis: Diagnosis and Conservative Management (PubMed)
- Plantar Fasciitis (APMA)
- Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
- Heel Pain (APMA)
Related Treatments at Balance Foot & Ankle
Our board-certified podiatrists offer advanced treatments at our Bloomfield Hills and Howell locations.