Home Program for Ankle Instability

What you are treating

An ankle that rolls again and again after a sprain has two problems. The ligaments on the outside of the ankle have been stretched, so there is less to catch the foot when it tips. And the sense of position in the ankle, the reflex that fires the muscles on the outside of the leg the instant the foot starts to roll, has been dulled by the injury. The second problem is the one that matters most and the one that can be retrained.

The muscles that do the catching are the peroneals, which run down the outside of the lower leg and pull the foot outward. The program below strengthens them and retrains the reflex that uses them. Most people with a wobbly ankle become stable with six to twelve weeks of this work. Surgery to tighten the ligaments is reserved for the ankle that still gives way after a genuine program.

Phase 1: settle it (first 1 to 2 weeks after a sprain)

• Rest from sport, ice for 15 minutes several times a day, a compression wrap, and the leg up when sitting.
• Walk as normally as you can with a lace-up ankle brace. Crutches only if walking is very painful, and for no more than a few days.
• Begin motion right away: trace the alphabet in the air with the big toe, 2 or 3 times, several times a day. Pump the ankle up and down 20 times every hour you are awake.
• Calf stretch at a wall, back knee straight then bent, 20 seconds each, 3 rounds, twice a day.

Phase 2: strengthen the peroneals (weeks 2 to 6)

Use a loop of exercise band around the foot, anchored to a table leg or the other foot. Three times a week at first, then every other day.

• Eversion (the key one). Sit with the leg straight and the band around the outside of the foot, anchored to the inside. Turn the foot outward against the band, slowly, and return slowly. 3 sets of 15. Make it harder by moving to a heavier band, not by going faster.
• Inversion. Band on the inside of the foot, turn the foot inward. 3 sets of 15.
• Dorsiflexion. Band over the top of the foot, pull the foot up. 3 sets of 15.
• Plantarflexion. Band under the ball of the foot, push down. 3 sets of 15.
• Calf raises. Standing on both feet, rise onto the toes, lower slowly. 3 sets of 15. Progress to one foot.
• Toe walks and heel walks, 20 steps each, 3 rounds.
• Hip strength. Side-lying leg raises and clamshells, 2 sets of 15 each side. A weak hip lets the whole leg tip inward and puts the ankle in the rolling position.

Phase 3: retrain the balance reflex (weeks 3 to 12)

This is the part that stops the ankle from rolling. Do it daily. Each stage should be steady for 30 seconds, three times in a row, before moving to the next. Stand near a counter or a wall the first few times.

1. Stand on one foot on the floor, eyes open, 30 seconds.
2. Same, eyes closed.
3. Stand on one foot on a pillow or folded towel, eyes open.
4. Same, eyes closed.
5. Stand on one foot on a pillow while tossing and catching a ball against a wall, or while turning the head side to side.
6. Single-leg stand while reaching the other foot forward, to the side, and behind (a star pattern), 5 reaches each direction.
7. Hops: two feet, then one foot, forward and back, then side to side, then in a square. Land softly with the knee slightly bent.

A wobble board or a balance disc, used for 5 minutes a day, speeds this up and is worth buying.

Phase 4: return to sport

• Jog in a straight line when you can hop ten times on the injured foot without pain. Add cutting and figure-eights a week later, then sport-specific drills at half speed, then full speed.
• Wear a lace-up ankle brace, or have the ankle taped, for every practice and game for the rest of the season and for six to twelve months after a bad sprain. It cuts the chance of another sprain roughly in half.
• Keep the single-leg balance and the eversion exercise as a two-minute habit, three times a week, for as long as you play.

Modalities

Ice after activity for swelling, 15 minutes at a time. Compression sleeves are reasonable for swelling in the first weeks. Heat before the stretches if the ankle is stiff. Ultrasound and electrical stimulation in the clinic are fine for comfort but do not replace the exercises; the band and the balance work are what make the ankle stable.

Notes for the physical therapist

• Emphasize peroneal strength and proprioceptive retraining; progress balance from stable to unstable surfaces and from eyes open to closed, then to perturbation and sport-specific tasks.
• Check and treat restricted dorsiflexion (talocrural mobilization) and hip abductor weakness.
• Use hop tests (single hop for distance, triple hop, crossover hop) at 90 percent of the uninjured side as the return-to-sport standard.
• Lace-up brace or taping for sport for 6 to 12 months.
• If the ankle still gives way after three months of a proper program, or if there is locking, catching, or persistent swelling, send the patient back to me: a stress X-ray or an MRI will look for a ligament that needs repair or an injury inside the joint.

When to call

• The ankle gives way with ordinary walking, or it locks or catches.
• Pain and swelling that are not improving after two weeks, or pain over the bone rather than the ligament.
• Numbness in the foot.
• Any concern that the ankle was fractured rather than sprained.

Learn more

OrthoInfo (AAOS), Sprained Ankle: orthoinfo.aaos.org (opens in a new tab)

My guides to ankle sprain and calf stretches for children and teens.

More for families

OrthoKids · POSNA

POSNA's OrthoKids: illustrated, family-friendly information on this condition.

Open on OrthoKids (opens in a new tab)

Scan for the OrthoKids page

This program is a starting place and a set of suggestions for your physical therapist, not a prescription. Your therapist will adjust it to your exam. Stop and call us if an exercise causes sharp pain or swelling, or if the ankle gives way with ordinary walking.