As medicine advances, more and more physicians are beginning to recognize that ankle sprains can lead to ligament damage, but there is a great deal of controversy in national opinion regarding the treatment after an ankle sprain. Each physician offers his or her own opinion based on his or her own experience and uses it as a basis for treatment. My opinion is very clear: for patients with first-time ankle sprains, after excluding fractures, a thorough evaluation and formal conservative treatment should be performed first, and for patients with pain/instability/discomfort that persists after up to 6 months of conservative treatment, early and appropriate further management, including surgery, should be performed depending on the symptoms. The basis for making this conclusion is strictly in accordance with the scientific principles of evidence-based medicine and comes not only from the summary of our own experience but also from the international relevant literature. The corresponding basis is as follows: 1. About 80%-85% of patients can recover well through various conservative treatments. However, more than 15% of patients will become chronically unstable, with residual intractable ankle pain and joint instability, and these patients often need to undergo surgery eventually1-2; 2. The internationally accepted rehabilitation program is mostly 12 weeks as the treatment course (3 months), which means that 12 weeks of conservative treatment should be effective, and conversely, if there is no effect, further examination and treatment may be required3-4; 3. -4; recovery of tissue damage after 3 or 6 months is less likely. For example: nerve injury after 6 months if there is no recovery will need to perform nerve release or functional reconstruction; fracture after 6 months does not heal is called bone non-union, and so on. This is especially true for the recovery of ligaments, cartilage and other poorly healing soft tissues. Therefore, the poor efficacy of conservative treatment after 6 months has been recognized internationally as a criterion for surgical treatment very early5; 4. For patients who need surgery, early surgery has better efficacy2. On the contrary, if conservative treatment is ineffective and patients who need surgical treatment simply refuse surgery, it may aggravate the condition and delay the timing of treatment. The longer the ankle ligament injury, the more serious the cartilage damage in the ankle joint6; 2. The longer the ankle sprain, the more frequent it is, the more serious the ligament resorption is, so that the opportunity of ligament suture is lost during surgery and only reconstructive surgery can be performed7; 3. 4. The longer the duration of ankle instability, the more pronounced the loss of balance sensation and may lead to contralateral ankle sprain9. 5. 17.5% of patients with ankle traumatic arthritis requiring total ankle replacement or ankle fusion had chronic ankle instability. Of these patients, 10.8% had habitual ankle sprains and 6.7% had only a single sprain. It shows that a single or habitual sprain of the ankle can further evolve into post-traumatic arthritis if left untreated.10 We often see injuries such as cartilage, free bodies, lower tibiofibular separation, synovitis, and bone redundancy during surgery (see Figures 1-4), and ask, how is it possible to recover from such injuries with conservative treatment? The only way to get better results is through surgical treatment! Although surgery is not a panacea, more often than not, timely surgical treatment can better restore motor function! Therefore, for patients with conservative treatment of ankle sprains with poor results for more than 6 months, attention must be paid: please further check and treat! Avoid more serious consequences!