Ankle sprains are among the most common injuries, from a missed step on the stairs to a twist during football or padel. Most heal well with rest and rehabilitation. But for some people, the ankle never feels quite right again. It keeps rolling, feels loose on uneven ground, and sprains again with little warning.

This is known as chronic ankle instability. Dr. Ahmed Al-Ammouri, a consultant orthopaedic surgeon in Amman, Jordan, specialises in minimally invasive foot and ankle surgery. He explains why it happens, how it is treated, and when keyhole surgery can help.

Why some sprains never fully heal

A sprain stretches or tears the ligaments on the outside of the ankle. If they heal in a lengthened, weaker position, the joint loses some of its natural stability. A sprain can also affect the small nerve sensors that help the ankle react to uneven ground, so balance and control suffer too.

“A sprain that keeps coming back is a sign the ankle needs attention,” Dr. Al-Ammouri said. “Each new sprain can put more strain on the joint, so it’s better to deal with the cause early.”

Signs your ankle may be unstable

  • The ankle “gives way”, especially on uneven ground or when changing direction.
  • Repeated sprains, sometimes from minor missteps.
  • Ongoing swelling, aching or tenderness on the outer side of the ankle.
  • A feeling of insecurity that makes you avoid sport or walking on rough surfaces.

Step 1: A proper assessment

Treatment starts with a careful examination of the ankle’s stability and strength. X-rays are taken where needed, and an MRI scan can show ligament damage and related problems such as cartilage injuries or inflamed tissue that pinches inside the joint (impingement).

Step 2: Structured rehabilitation first

For most people, the first treatment is not surgery. A structured physiotherapy programme focuses on balance training, strengthening the muscles that support the ankle, and gradually returning to activity. Some people also benefit from a brace or taping during sport.

“Most unstable ankles improve with the right rehabilitation,” Dr. Al-Ammouri said. “Surgery is for the ankles that still give way after a proper programme.”

Step 3: When surgery is considered

Surgery may be recommended if the ankle remains unstable despite several months of structured rehabilitation, or if scans show damage inside the joint that is causing ongoing pain or catching.

Step 4: What keyhole ankle surgery involves

Minimally invasive ankle surgery often starts with an ankle arthroscopy. A small camera is passed into the joint through tiny incisions so the surgeon can examine it and treat problems such as impingement, loose fragments or cartilage damage. The loose ligaments can then be repaired or tightened, often through small incisions.

“Working through small incisions means less disruption to the surrounding tissue,” Dr. Al-Ammouri said. “For many patients that means smaller scars and a more comfortable start to recovery.”

What recovery looks like

Recovery is gradual and depends on what was done during surgery. Patients usually spend a period in a protective boot, with guidance on how much weight to put through the foot. This is followed by physiotherapy to rebuild movement, strength and balance. A return to running and sport is phased in over several months, based on how the ankle responds rather than on the calendar alone.

Questions to ask your surgeon

  1. Has my rehabilitation been long and structured enough before considering surgery?
  2. What do my scans show besides the ligament injury?
  3. Will you repair the ligament, and will you also treat anything inside the joint?
  4. How long will I be in a boot, and when can I drive and return to work?
  5. When can I realistically return to my sport?

When to seek urgent care

Seek urgent medical help after an ankle injury if you cannot put any weight on the foot, the ankle looks deformed, there is severe swelling or bruising, or the foot feels numb, cold or tingly. These can be signs of a fracture or other serious injury.

For patients in Jordan and the region

Dr. Al-Ammouri sees patients at his clinic in Shmeisani, Amman, opposite The Specialty Hospital. Patients from neighbouring countries can share their MRI scans and reports for an initial review before planning a visit. He also publishes short videos explaining foot and ankle problems in plain Arabic for his more than 39,000 Instagram followers.

About Dr. Ahmed Al-Ammouri