Persistent ankle pain, swelling, and crepitus should suggest the possibility of osteocartilagenous lesions of the talar dome in some patients with ankle pain. Tomograms may be required to demonstrate their presence.Excision or excision and curettage of these lesions have been shown to provide a good result in 63%, and a fair result in 30% of the 31 cases that failed to respond to nonoperative treatment.Osteocartilagenous lesions of the talar dome appear to have a traumatic etiology. In the talar dome, what has been called osteochondritis dissecans, is, in most cases, a transchondral fracture.