Ankle sprains are a common sports injury that can cause significant, chronic disability. Studies aimed at prevention through the use of footwear have focused on the biomechanical aspects of foot and ankle anatomy, proprioceptive input of the foot/ankle complex, external stresses applied to the joint, and shoe traction. These studies support the use of high top shoes for ankle sprain prevention because of their ability to limit extreme ranges of motion, provide additional proprioceptive input and decrease external joint stress. Despite this biomechanical evidence, clinical trials are inconclusive as to the clinical benefit of high top shoes in the prevention of ankle sprains. Further study is necessary to delineate the benefits of shoe designs for ankle sprain prevention.