"I only rolled, but it didn't feel too bad, and it got better in a few days."
It's a common thing that I hear from tennis players in clinic.
You twist your ankle chasing a wide forehand, it swells for a few days, you rest it, maybe wear a support, and before long you're back on court.
Everything seems fine… until a few weeks or months later it happens again. And then again.
If this sounds familiar, you're certainly not alone.
Recurrent ankle injuries are incredibly common in tennis players of all ages and standards.
The good news is that they aren't something you simply have to live with. More often than not, there's an underlying reason why the ankle keeps letting you down, and with the right diagnosis and treatment we can usually get you back to playing with much more confidence.
Tennis places enormous demands on your ankles.
Unlike running in a straight line, tennis is full of explosive changes of direction. You're accelerating forwards, stopping suddenly, shuffling sideways, pivoting, jumping for serves and overheads, then landing on one leg before pushing off again.
Every rally asks your ankle to absorb force while remaining stable.
The faster you play, the greater these forces become.
Grass courts can be slippery, clay allows your foot to slide, while hard courts generate higher impact forces. Add in fatigue during a long match and it's easy to see why ankles are particularly vulnerable.
Around 85% of ankle sprains involve the ligaments on the outside of the ankle (the lateral ligaments).
The typical injury happens when your foot lands awkwardly and rolls inwards.
This movement is called inversion, and it overstretches the ligaments that normally stop the ankle from rolling too far.
You might hear or feel a pop, followed by pain, swelling and difficulty putting weight through the foot.
Sometimes the injury is obvious after landing on another player's foot in doubles, but more often it's surprisingly simple:
Even experienced players with excellent footwork can suffer ankle sprains.
This is the question most people ask me.
The first injury often isn't the real problem. It's what happens afterwards.
When you sprain your ankle, the ligaments don't just provide mechanical support, they also contain tiny nerve endings that tell your brain exactly where your foot is in space. This is known as proprioception or joint position sense.
Following an ankle sprain, these sensors don't always recover fully; especially if you don't have specialist rehab.
As a result, your reactions become slightly slower, your balance is affected, and the muscles around the ankle don't stabilise the joint quite as effectively.
Most people don't notice this in everyday life.
On a tennis court, however, where movements happen in fractions of a second, these small changes become much more important.
If rehabilitation is rushed, or skipped altogether, the ankle may remain weak and unstable, making another sprain much more likely.
Each subsequent injury can stretch the ligaments a little further, creating an ongoing cycle of instability.
Not necessarily.
One of the biggest mistakes I see is assuming every painful ankle is simply another sprain.
Sometimes the injury is actually:
These conditions often produce similar symptoms initially but require very different treatment.
That's why getting the correct diagnosis early is so important.
I would recommend being assessed if:
Many patients tell me they've simply learned to "manage" their ankle by taping it or wearing a brace.
While these can sometimes help temporarily, they rarely address the underlying cause.
The first step is listening carefully to your story.
How did the injury happen? How many times has it occurred? What movements cause problems? When do you feel unstable?
I then carry out a detailed examination looking at:
Very often, the way your foot, knee and hip work together provides important clues.
If necessary, imaging such as X-rays or MRI scans can help identify injuries that may not be obvious during examination, particularly if symptoms have persisted or you're not improving as expected.
One of the biggest myths is that ankle sprains simply need rest.
Rest is important in the first few days to allow the initial inflammation to settle, but long-term recovery depends on restoring strength, balance and confidence.
Treatment is usually tailored to the individual but may include:
This is the cornerstone of successful treatment.
Exercises gradually rebuild:
These aren't just generic ankle exercises — they should prepare your ankle for the exact demands of your sport.
In some cases, restoring normal movement through the ankle joint can improve mobility and reduce discomfort.
These can provide additional support during the return to tennis, particularly after more significant ligament injuries.
However, I see them as a temporary aid rather than a permanent solution.
The ankle doesn't work in isolation.
Weakness around the hips, gluteal muscles or core can alter the way forces travel through the leg, increasing the load placed on the ankle.
Addressing these areas often reduces the risk of further injury.
Fortunately, most tennis players won't need surgery.
A structured rehabilitation programme remains the first line of treatment, and many people recover fully with the right physiotherapy and gradual return to sport.
However, surgery becomes a very good option when the ankle simply isn't responding to conservative treatment.
I usually start discussing surgery with patients who have:
This is particularly relevant for competitive tennis players, active recreational athletes and younger patients who want to continue playing sport for many years. If your ankle repeatedly lets you down every time you push off for a serve or change direction, surgery can restore the stability that rehabilitation alone sometimes cannot.
My aim is to restore the natural stability of your ankle while preserving its normal movement.
The operation I perform most commonly for chronic ankle instability is based on the Modified Broström-Gould repair, which is considered the gold standard procedure for repairing damaged lateral ankle ligaments.
In most cases, I'm able to repair and tighten your own stretched ligaments and the surrounding joint capsule, rather than replacing them.
For the majority of my patients, I also reinforce this repair using an InternalBrace™. This is a strong, tape-like implant that acts as an additional support while your ligaments heal.
It doesn't replace your ligaments; instead, it protects and augments the repair, allowing your own tissues to recover more securely.
I find the InternalBrace particularly beneficial for patients whose ligaments have become very stretched or weakened after repeated sprains, those with particularly high sporting demands, or anyone requiring revision surgery following a previous failed repair. Because it provides immediate additional stability, it can also support a more confident rehabilitation programme, helping patients regain strength and function sooner than with ligament repair alone.
Whenever appropriate, I also perform an ankle arthroscopy (keyhole surgery) at the same time.
This allows me to look inside the joint for any hidden damage that may have resulted from repeated ankle sprains, such as cartilage injuries, inflamed tissue, scar tissue causing impingement or loose fragments.
If I find any of these problems, I can often treat them during the same operation.
In severe cases where the native ligaments are too damaged to repair — perhaps following multiple previous injuries or failed surgery — a full ligament reconstruction using a tendon graft may be recommended instead.
Every ankle is different, so I tailor the procedure to the individual.
Recovery isn't instant, but most patients are pleasantly surprised by how steadily they progress.
Typically, recovery involves:
Returning to competitive tennis usually takes several months rather than several weeks, but the aim is not simply getting you back onto court quickly, it's getting you back with a stable ankle that you can trust.
This is often the question patients ask first.
Thankfully, the evidence is very reassuring.
A large 2024 systematic review including more than 1,300 patients found that:
Other systematic reviews have shown that both open and arthroscopic ligament repairs provide excellent improvements in ankle stability, pain and function, with low complication rates and high patient satisfaction.
Perhaps just as importantly, many patients tell me they regain something that's difficult to measure — the confidence to move freely again.
Instead of constantly worrying that the ankle will roll during every wide forehand or awkward landing, they can concentrate on playing tennis.
That confidence is often just as valuable as the ligament repair itself.
In many cases, yes, absolutely.
The players who stay injury-free are rarely those with the strongest ankles, they're usually the ones who continue doing consistent rehab exercises, even when their ankle is better.
Simple balance exercises, calf strengthening, hopping drills and tennis-specific movement training all help maintain stability.
Equally important is allowing enough recovery between matches and avoiding returning to full competition before the ankle is ready.
If your ankle keeps rolling over, don't simply accept it as part of playing tennis.
Recurrent ankle sprains are often a sign that something hasn't fully recovered, and continuing to play through repeated injuries can eventually lead to long-term instability and arthritis later in life.
The sooner we identify what's causing the problem, the sooner we can put together a treatment plan that gets you back on court safely, and helps keep you there!
Martin Klinke is one of the leading ankle surgeons in London. With an impressive background in both Orthopaedics and Sports Medicine, he takes a comprehensive and compassionate approach to your treatment. He’s a trusted, reputable surgeon who can help get you back in the game!
Mr Martin Klinke offers outpatient consultations at the Cleveland Hospital and the Cleveland Clinic in London.
You can find all his patient reviews here.
