Talus osteochondral lesions have difficult and complex treatment procedures, and give pain as symptoms with activity. Magnetic resonance imaging is the preferred way of diagnosis, follow-up, and classification of the lesions. The prognosis is bad in the lesions bigger than 1.5 cm2, uncontained lesions in talus shoulder, and the lesions with subchondral cysts. The treatment must be limited to symptomatic patients. The effect of conservative treatment is limited and only symptomatic. Surgical treatments are preferred for active patients and those with severe symptoms. The aim of surgical treatment is to obtain hyaline-like cartilage. The mainly used surgical procedures are microfracture in lesions smaller than 1.5 cm2, and mosaicplasty in bigger ones. In adjunctive treatment of microfracture cell-free scaffolds, concentrated bone marrow aspirate, hyaluronic acid, and platelet-rich plasma are used. In the lesions bigger than 3 cm2 and in revision surgery, osteochondral allograft transplantation, autologous chondrocyte implantation, and resurfacing arthroplasty are the preferred surgical procedures.