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Management of acute ankle sprains varies according to medical practice, leading to disparities in treatment and risk of complications, particularly chronic instability. The aim of this study is to identify good practice according to recent recommendations, and to explore strategies for the therapeutic management of chronic instability, including imaging and new surgical techniques. The study is based on a review of the literature on lateral ligament sprains. Diagnosis is based on clinical examination, with high reliability (sensitivity 96%, specificity 84%). Ultrasound and the Ottawa rules help in the diagnostic decision. Initial treatment is based on the RICE protocol and immobilization, followed by neurosensory and muscular rehabilitation. MRI is indicated in cases of persistent pain. Surgical treatment is reserved for resistant cases. Appropriate initial management is essential to prevent complications and limit healthcare costs.