Ankle sprains, particularly high ankle sprains (syndesmotic injuries), are among the most common lower limb injuries in athletes with significant impact on recovery and long-term functional outcomes. Although they are less common than lateral ankle sprains, syndesmotic injuries can lead to persistent pain, instability, and functional limitations. Recent literature demonstrated an increasing incidence of isolated syndesmotic injuries, particularly in elite athletes. This can be explained by the greater training intensities, advancements in diagnostic techniques, and better understanding of the condition. This chapter reviews the pathophysiology, risk factors, mechanisms, and management strategies for both acute and chronic syndesmotic injuries.