Isolated lesions of the syndesmosis are quite usual in high-impact sports, accounting for up to 30% of all ankle sprains. The syndesmotic ligaments prevent the lateral translation of the fibula. Therefore, disruption of one of these ligaments can lead to instability of the joint and deranged axial movement. The determination of clinically relevant syndesmotic instability represents a challenging and complex problem. An accurate clinical diagnosis is insensitive in the context of an acute ankle lesion since many patients localize a tender spot over the syndesmosis. Clinical diagnostic tests aim to reproduce symptoms by applying stress to the syndesmosis. Ideal management should be directed toward adequate rehabilitation and early return to play without undermining long-term functionality and minimizing reinjury. Even once the diagnosis has been established by clinical and/or intraoperative tests, there seems to be no consensus about the optimal management of these injuries. Despite the development of multiple techniques for syndesmotic fixation, there remains a lack of consensus in terms of the best surgical treatment option. In the absence of instability or frank diastasis, nonsurgical management results in a return to play typically between 2 and 6 weeks after injury. Surgical fixation of unstable syndesmotic injuries is performed in elite athletes as it is claimed to shorten return to play times, although supporting evidence is scarce. Most athletes are able to recover from ankle syndesmotic injuries and return to play at their preinjury performance.