Background <p>Acute distortion of the ankle joint (OSG) is one of the most frequent injuries of the musculoskeletal system and occurs in daily life as well as in sports activities. Particularly affected are the lateral ligaments and the distal tibiofibular syndesmosis. In addition to acute impairments there is a high risk for recurrence and the development of chronic ankle instability with relevant functional and socioeconomic consequences.</p> Objective <p>The aim of this article is the structured presentation of the conservative treatment of injuries of the ankle joint and the syndesmosis taking current evidence-based guidelines, clinical diagnostics and rehabilitation concepts into account.</p> Methods <p>The anatomy, typical injury mechanisms, clinical examination, functional tests, imaging and classification of injuries to ligaments and syndesmosis are presented based on the current literature. Building on this, the indications for conservative treatment and phase-oriented rehabilitation concepts are described.</p> Results <p>Grades I and II injuries of the lateral ligaments and stable injuries of the syndesmosis can usually be successfully treated using conservative approaches. An early functional deficit-oriented rehabilitation with controlled increased in loading, restoration of joint mobility, strengthening and improvement of postural control reduce the risk of recurrence and promote the return to daily life, occupation and sport. In cases of high-grade injuries of the syndesmosis a cautious approach to loading is essential to avoid complications.</p> Conclusion <p>Conservative treatment represents and effective treatment option in selected injuries of the ankle joint and syndesmosis. Prerequisites for a good functional result are precise diagnostics, correct classification of the injury and a structured, phase-adapted rehabilitation.</p>