Osteochondral lesions of the foot and ankle—most commonly involving the talus—pose significant diagnostic and therapeutic challenges in athletes due to high functional demands and the limited intrinsic healing capacity of articular cartilage. This review summarizes the epidemiology, pathophysiology, clinical evaluation, imaging modalities, and classification systems relevant to these injuries, with a focus on the talus, tibial plafond, and first metatarsophalangeal joint. Management strategies range from nonoperative care for stable lesions to surgical approaches aimed at restoring the structure and function of the joint surface. Surgical decision-making is guided by lesion size, morphology, location, chronicity, and associated pathology, with an emphasis on restoring joint congruity, preserving cartilage, and optimizing long-term outcomes. Special consideration is given to the athletic population, where timely return to pre-injury performance levels and career longevity are critical. Available evidence on return-to-sport rates, prognostic factors, and long-term durability is reviewed, providing an updated framework for treatment selection and patient counseling.