The highway passes through the communities of Woodham and Kirkton, crossing completely into Perth County just north of the latter.

It later enters Russeldale, meeting the eastern terminus of former Highway 83[3] (County Road 83) as it swerves north.

Approximately 9 kilometres (5.6 mi) beyond there it enters the town of Mitchell, where it is known as Blanchard Street.

Midway between Mitchell and the village of Monkton, the highway bisects the community of Bornholm within the municipality of West Perth.

The route gently curves to the east before turning north at an intersection just west of Palmerston, where it crosses the boundary into Wellington County and the Town of Minto.

[4] The following table lists the major junctions along Highway 23, as noted by the Ministry of Transportation of Ontario.