Osteochondral lesions (OCL) of the talus are being recognized as a steeply rising sports injury. They can be found as concomitant injury in up to 50% of all ankle sprains. Damage to articular cartilage at the ankle can lead to osteoarthritis in midterm or long term and impede patients significantly in their quality of life and restrict sports and recreation activities. Still, the management of OCL of the talus represents a challenge to the treating physician. The etiology and pathophysiology of OCL of the talus are not clearly known yet. Even though trauma seems to be the most common reason, it is likely that a variety of etiological factors may play a substantial role of development of OCL, e.g., a flatfoot deformity. Magnetic Resonance Imaging (MRI) is the gold standard imaging tool for radiographic diagnostic of OCL of the talus. However, conventional weight-bearing radiographs should routinely be done for standard diagnostics, exclude fractures, and evaluate the biomechanical alignment. Symptomatic and/or deep OCL of the talus should be treated first conservatively: insoles, physiotherapy, and viscosupplementation. However, in the majority of the cases, surgery is not avoidable. There are several different surgical treatment strategies, which are described in this chapter. Indications for the surgical treatment and their advantages and disadvantages are herewith described.