The management of osteochondral lesions of the talus (OLT) remains a challenging clinical issue. With advances in theory and technology, treatment options for OLT have expanded significantly. This review examines recent progress in the clinical treatment of OLT, focusing on studies published from 2021 to 2023. We searched PubMed, Embase, and Cochrane databases to identify relevant clinical treatments, including both nonsurgical and surgical approaches. Surgical advancements have primarily centered on microfracture, bone transplantation, cartilage transplantation, combined cell therapy, and biomaterials. Among these, some innovative methods, such as autologous costal cartilage transplantation and biological scaffolds, have yielded promising clinical outcomes. However, high-quality clinical studies are still lacking, particularly those exploring nonsurgical treatments and physical therapy. Future research may increasingly focus on integrating biomaterials with physical therapy, which holds potential for improving patient outcomes.