Acute ankle sprains are a common musculoskeletal injury. As part of the physical examination, a combination of ankle-specific tests should be used to evaluate ligaments. Delaying the examination until 4 to 7 days postinjury increases diagnostic accuracy of sprain severity. In the acute setting, the Ottawa Foot and Ankle rules can help determine when radiography does not need to be ordered to evaluate for fracture. Management of acute ankle sprains should include joint protection, pain control, external ankle supports for 5 to 10 days, early functional activity, and targeted rehabilitation exercises. Oral medications such as acetaminophen, nonsteroidal anti-inflammatory drugs, and opioids are equally effective in managing pain. Recovery includes the use of external ankle supports (eg, semirigid braces) and a targeted neuromuscular rehabilitation program for 8 to 12 weeks. Continuing functional exercises and the use of external ankle support during sport after recovery can aid in the prevention of recurrent ankle sprains. If an ankle sprain does not follow the expected course of recovery, further evaluation with magnetic resonance imaging should be performed to evaluate for other causes of acute lateral ankle injuries, such as talar fractures and peroneal tendon injuries.