This narrative review addresses the evaluation and management of calcaneal malunion — a disabling complication that can follow calcaneal fractures regardless of initial treatment. It systematically links the pathoanatomy of malunion to specific symptom patterns and outlines the spectrum of nonsurgical and surgical options, from orthoses and injections to distraction bone block arthrodesis and corrective osteotomy.
When a patient presents with pain after a calcaneal fracture, localize the source systematically — lateral pain (peroneal/sural/subtalar), anterior pain (talar neck impingement from height loss), medial pain (tarsal tunnel/FHL tethering), or plantar pain (heel pad injury) — because surgical correction only works if it precisely targets the underlying pathoanatomy.
Exhaust nonsurgical options first, then match the procedure to the deformity: lateral wall ostectomy for Stephens Type I, in situ fusion for Type II without height loss, distraction bone block for Type II–III with anterior impingement, and corrective osteotomy plus fusion for severe Type III deformity.
This narrative review addresses the evaluation and management of calcaneal malunion — a disabling complication that can follow calcaneal fractures regardless of initial treatment. It systematically links the pathoanatomy of malunion to specific symptom patterns and outlines the spectrum of nonsurgical and surgical options, from orthoses and injections to distraction bone block arthrodesis and corrective osteotomy.
When a patient presents with pain after a calcaneal fracture, localize the source systematically — lateral pain (peroneal/sural/subtalar), anterior pain (talar neck impingement from height loss), medial pain (tarsal tunnel/FHL tethering), or plantar pain (heel pad injury) — because surgical correction only works if it precisely targets the underlying pathoanatomy.
Exhaust nonsurgical options first, then match the procedure to the deformity: lateral wall ostectomy for Stephens Type I, in situ fusion for Type II without height loss, distraction bone block for Type II–III with anterior impingement, and corrective osteotomy plus fusion for severe Type III deformity.