Ankle sprains are among of the most common injuries seen in daily orthopaedic practice. Beside injuries of the lateral ligament, which is the most frequently injured single structure in the body of athletes, sprains can also affect the tibiofibular syndesmosis. These injuries are known as high ankle sprains. They can occur with or without a bony injury. In this report, we will discuss the high ankle sprain without any bony injury. These kinds of injuries are rare, but often associated with complications and are frequently misdiagnosed or undiagnosed. The purpose of this article is to provide a clear understanding of clinical tests described in the literature for testing of syndesmotic integrity.