A case of medial posttraumatic osteochondral lesion of the talus (OCLT) in a 25-year-old patient is reported. The potentially unclear symptomatology associated with this type of lesion is emphasized, and the imaging procedures as well as the classification systems based on these procedures are reviewed. The value of open surgery for curettage and drilling of a large zone of chondral defect with underlying osteosclerosis of the medial talar dome is evaluated. Compared to standard radiography and bone scan, magnetic resonance imaging (MRI) appears to correlate well with the intraoperative findings and is therefore useful as both a diagnostic and a prognostic tool. Our observations suggest that, even when a large zone of osteosclerosis underlies a medial chondral defect, drilling alone of this zone - after curettage of the detached cartilage - may be sufficient to lead to a good functional result. Bleeding out the healthy underlying cancellous bone through the drilling holes made in the sclerotic zone may be sufficient to restore part of the vitality and stability of the medial talar dome and is less invasive than osteochondral grafting.