What it is

Ankle instability in youth athletes refers to the repeated giving way and sprains that occur after an initial injury. It can include mechanical laxity and functional deficits in balance and strength, and impact the performance and degeneration (arthritis) risk profile of athletes as they age, and is common in youth athletes. It can also be referred to as Chronic Ankle Instability (CAI). CAI is characterised by a persistent feeling of instability and repeated episodes of the ankle giving way, stemming from damage to the lateral ligaments (ligaments on the outside of the ankle), most often following previous ankle sprains.

Without rehabilitation, the risk of re-injury remains high. Early prevention strategies focusing on physical activity from the start of sport participation are crucial. Management includes functional rehabilitation programs, bracing, and potentially surgery for severe cases, with a focus on restoring balance, coordination, and strength through targeted exercises.

What happens when it occurs

Ligament injury heals, but sensorimotor control remains impaired. Balance, strength, and movement patterns must be rebuilt.

Why is it important for youth athletes

  • High Prevalence: CAI is common in adolescent athletes, with some studies finding over 45% prevalence.
  • Impact: It can negatively affect an athlete's quality of life, leading to pain, fear of movement, and a reduction in physical activity, especially in young adulthood.
  • Long-Term Consequences: Untreated CAI can lead to more severe movement impairments, potential damage to the ankle's cartilage, and other complications.

Common causes and risk factors

  • History of ankle sprain with incomplete rehabilitation
  • High change of direction and jumping sports
  • Cavus foot shape and limited ankle dorsiflexion
  • Poorly managed previous ankle injury
  • Return to play before the criteria are met from a previous injury

Who is most affected

Field and court sport athletes in school and club programs.

Typical symptoms

  • Recurrent sprains and episodes of “giving way”
  • Loss of ankle muscle strength
  • Outer ankle pain or swelling after activity
  • Fear of turning or landing awkwardly – reduced confidence

When to seek care

If sprains recur, if swelling persists, or if sports confidence remains low after rest.

How we diagnose

History of recurrent sprains, balance testing, hop and agility tasks, and ligament stress tests. Imaging is used when a tear or osteochondral injury is suspected.

Management and Prevention

  • Prevention: Implement injury prevention strategies from the beginning of sport participation, not just when an injury occurs.
  • Functional Rehabilitation: Focus on exercises that enhance balance, coordination, and ankle strength. Balance and proprioception training daily. Peroneal and calf strengthening exercises with progressive hopping and cutting movements.
  • Prophylactic Bracing: External support with taping or bracing during return phases can help prevent further instability and injury.
  • Screening: Use enhanced screening methods to identify athletes at risk based on known risk factors.
  • Return-to-Play (RTP) Guidelines: An objective assessment of the athlete's function and stability is needed to determine if they are ready to return to sport safely.
  • Surgery: Anatomic surgical repair or reconstruction may be considered after other non-operative measures have failed, resulting in persistent mechanical laxity.

Rehabilitation milestones

Phase 1 weeks 0 to 2: swelling control, balance basics, peroneal isometrics.

Phase 2 weeks 2 to 6: heavy slow strength, wobble board, running drills.

Phase 3 weeks 6 to 12: hopping, change of direction, sport drills.

Phase 4 months 3 to 6: full training with criteria-based testing.

Readiness to progress

  • Single leg stance, eyes closed 20 to 30 seconds
  • Peroneal strength within 90 per cent
  • Hop and agility tests completed without next-day flare

Prevention

  • Continue balance work two to three days per week
  • Use braces or tape during high-risk sessions until strength and balance are robust.
  • Progress training volumes gradually

Australia snapshot

  • Ankle sprain is one of the most common injuries in junior sports
  • Re-sprain risk is highest in the first months after return without a balance program
  • Access to school and club rehabilitation support varies by region

Latest insights

Balance training and strength training change the re-sprain story. Support with tape or a brace while you rebuild control.

Use criteria for returning to play and maintain a program in the background.

Frequently Asked Questions

Chronic ankle instability is typically a result of inversion ankle sprains, where the ankle is sprained as the foot turns inwards. Most of the time, the Anterior Tala-Fibular Ligament (ATFL) is injured, along with the Calcaneofibular Ligament (CFL).

Left untreated, an unstable ankle joint can significantly impact function and overall quality of life. It can eventually lead to chronic pain and arthritis.

Many return to training in 6 to 8 weeks and to matches after passing the hop and agility tests. Timelines vary with severity and sport.

Some of these factors, such as increased heel height, may place the lower extremity in a compromised position, making the person vulnerable to ankle sprains. Basketball shoes with an increased heel height may also prevent normal pronation motion, increasing the risk of lateral ankle sprains.

Generally not. An injury to the lateral ankle can lead to both functional and mechanical instability of the ankle. However, an ankle may be predisposed to lateral ankle instability due to hereditary ligamentous conditions such as Ehlers-Danlos syndrome, Marfan syndrome, and Turner syndrome.

Taping or bracing reduces the risk of re-injury during the early phases. Gradually reduce as balance and strength improve.

Single-leg balance, hop tests, change of direction drills, and confidence checks.

Yes, at easy paces on flat ground if pain is low and following day symptoms are stable.

When mechanical laxity persists and sprains recur despite a complete rehabilitation block.

Train skills that do not compromise your balance while you rebuild it and regain strength.