Background Lateral ankle sprains (LASs) are one of the most common athletic injuries, yet there is limited descriptive data on clinical management of these injuries. A better understanding of  current practice will assist in identifying factors that may lead to poor outcomes and/or recurrent injuries.

Objective Describe the current clinical practice for treating LASs in the high school and collegiate settings.

Design Cross-sectional.

Setting High school and collegiate athletics.

Participants 7888 athletic trainers (ATC) working in a high school or college setting were included in the study. A 22% response rate yielded 1765 responses, 259 responses were excluded, as the respondents were not currently working clinically.

Interventions Participants were requested to complete an electronic survey, which focused on two domains: (1) strategies used to treat/rehabilitate LASs, and (2) the utilisation/attitudes related to ankle prophylaxis.

Main outcome measurements The survey contained 40 items, consisting of yes/no, categorical and Likert-scaled questions. Face validity was determined by a group of athletic trainers and sports injury researchers. Day-to-day reliability was evaluated prior to administration of the survey (r = 0.79).

Results The majority (81.8%) of ATCs surveyed altered LAS care based on the degree of sprain. Seventy percent immobilised grade 2 LASs for 2 days with a walking boot or crutches while 98.1% immobilised grade 3 LASs for 4–7 days with a walking boot. Grade 1 LASs are generally not immobilised. Only 24.2% of ATC’s utilised patient-reported outcomes in determining return to play criteria and 92.0% required athletes to utilise some form of prophylaxis when returning to participation.

Conclusions This is the first cross-sectional investigation on the practice of treating LASs. It is clear that there is general agreement on the treatment and management of LASs at the high school and collegiate level but there is need for further research and education in a number of areas to fully understand and implement an evidence-based approach to treating LASs.