Operative treatment of lesions of the medial talar dome can be very challenging. An osteotomy of the medial malleolus can provide adequate access for posteromedial talar dome lesions. The authors describe the technique of a chevron-type medial malleolar osteotomy. This particular osteotomy provides excellent exposure, with minimal morbidity, for the treatment of medial talar dome lesions in which standard arthrotomy or arthroscopic exposures are inadequate.