A 19-year-old female college equestrian team member had a 6-month history of right lateral ankle pain with weight bearing and swelling. The symptoms interfered with her desired activity level and horseback riding. She reported that she had originally fallen from her horse but was uncertain of the mechanism of her ankle injury. She noted immediate lateral ankle pain and swelling. Findings on initial evaluation in her hometown (including ankle x-rays) were believed to be consistent with a right lateral ankle sprain. With protective taping, she returned to competitive riding within 5 days of the injury. She saw an ankle and foot specialist 1 month later. X-rays were not obtained at that visit.