A 26-year-old woman presented a rare double localization of an osteoid osteoma of the ankle. The first focus was situated in the tibial metaphysic, bordering the distal tibiofibular joint. The second focus was also superficial, located in the neck of the homolateral talus. Percutaneous drilling was performed for both localizations under computed tomographic (CT) guidance. The postoperative period was uneventful and the patient has remained symptom-free at four years follow-up. Compared with disphyseal localizations, it is often more difficult to recognize an osteoid osteoma located in the foot or ankle. Scintigraphy and CT are necessary and sufficient for diagnosis. Progress in imaging techniques has greatly facilitated the treatment of osteoid osteomas, allowing excellent outcome with limited morbidity.