Ankle sprains that primarily involve the anteroinferior tibiofibular ligament are reportedly uncommon, but the authors have recently seen several such injuries in their clinic. These high ankle sprains usually are caused by forced lateral rotation with the foot in dorsiflexion. Edema and ecchymosis are generally minimal, with pain and tenderness over the distal anterior tibofibular syndesmosis. Pain and disability can persis for weeks. Rehabilitation consists of range-of-motion exercises leading up to weight-bearing and often takes much longer that the initial symptoms might suggest.