Talar dome lesions (TDL) have increasingly been the focus of interest of many foot and ankle surgeons over the past decade. The most important treatment aspect of TDL is diagnosis, so that appropriate treatment protocols can be enacted in a timely and stepwise manner. Minor or mild TDL may be treated conservatively, while severe acute or chronic TDL can be addressed with various surgical interventions. By being aware of all practical treatment options and their indications, success rates, benefits, risks, and alternative options, specialists will be able to make an informed decision on appropriate care selection after perusing this article.