The ankle sprain that never quite healed

July 7, 2026 · 3 min read · Foot and Ankle Associates

An ankle that keeps giving way after an old sprain usually has two problems: ligaments that healed stretched, and balance reflexes that were never retrained. Both are treatable, and the balance component responds to simple daily practice that most people were never told to do.

Why one sprain leads to the next

When the ankle rolls, the ligaments on the outside stretch or tear. They heal, but often at a slightly greater length than before, so the joint has more play in it than it should.

The less obvious damage is to proprioception, the sense that tells your brain where the joint is without looking. Those nerve endings sit in the ligaments and are disrupted by the injury. Without retraining, the reflex that catches the ankle as it starts to roll fires too slowly.

The result is an ankle that is both looser and slower to protect itself. Each subsequent sprain stretches the ligaments further and dulls the reflex more, which is why people describe a lifetime of weak ankles after one bad injury in their twenties.

What proper rehabilitation looks like

The first days are rest, ice, compression and elevation, which most people do. The part that is routinely skipped is what comes after the swelling settles.

Balance retraining is the core of it and requires no equipment. Stand on the injured leg near a counter for support, thirty seconds at a time, several times a day. When that becomes easy, do it with your eyes closed, which removes vision and forces the ankle to do the work.

Strengthening follows, particularly the muscles running down the outside of the lower leg that actively resist rolling.

The timescale that surprises people is how long the reflex takes to return. Strength comes back within weeks; the reaction that catches a rolling ankle needs consistent practice over two to three months, which is well past the point most people consider the injury finished.

What to stop doing

Returning to sport while the ankle still swells after activity. Swelling means the joint is still reacting, and a partly healed ligament sprains again easily.

Relying permanently on a brace without doing the balance work. A brace is useful on uneven ground and during return to sport, but if it substitutes for retraining the reflex, the ankle stays dependent on it.

When an old ankle needs examining

Repeated giving way, ongoing swelling months later, pain deep in the joint rather than over the ligaments, or a catching or locking sensation all warrant a look. Those can indicate damage to the joint surface or a fragment that the original injury caused and nobody imaged.

If you could not bear weight at the time of the injury, it is worth having the ankle assessed even years later, because fractures are missed in sprains more often than people expect.

Instability that has been present for years is still very treatable. It does not have to be permanent, which is the thing most people with weak ankles have never been told.

Where ligaments are too stretched for retraining alone to hold the joint, they can be tightened surgically, and the balance work still matters afterward. Most people never reach that point, because the reflex training does more than they expect.

Common questions

How long should an ankle sprain take to heal?

A mild sprain settles in two to four weeks, a more severe one in two to three months. Giving way that continues beyond that points to instability rather than incomplete healing.

Should I use a brace permanently?

A brace helps on uneven ground and during return to activity. Used instead of balance retraining it can keep the ankle dependent, so it works best alongside the exercises rather than in place of them.

Can an old ankle injury cause arthritis?

Repeated instability increases wear on the joint surface over time, which is one of the practical reasons to treat instability rather than live with it.