In this report, we present the diagnosis and clinical outcome of four patients with fractures of the posteromedial process of the talus. In two patients, the posteromedial process fracture was missed initially, which led to painful nonunions. One patient was treated with excision of a nonunion, and the other patient with a nonunion refused further surgery. Two patients underwent ORIF through a posteromedial approach. CT scans were useful in defining the fracture in all four patients. Cast treatment was recommended for displaced fractures or fractures without significant subtalar joint involvement. ORIF was recommended for displaced fractures with significant subtalar joint involvement.