Calcaneus fractures are common injuries of the foot and account for approximately 60% of all tarsal bone fractures. These injuries frequently result after axial loading of the foot such as after falls from heights onto the feet. Most of these fractures are intra-articular and are often associated with significant articular damage thus leading to high rates of post traumatic arthritis. Given their high energy mechanism, these injuries often are accompanied by other injuries such as spine fractures. There is ongoing debate as to the optimal management of these injuries. Anatomic reduction of the articular surface is associated with good long-term outcomes; therefore, many orthopedic providers recommend surgery. Unfortunately, there is a high rate of complications following surgical fixation due to the fragile soft tissue envelope surrounding these injuries such as infection and wound dehiscence. It is well documented in the literature that certain patients do worse with surgery such as smokers, males, and those with workers’ compensation claims. Nonoperative management avoids the complications associated with surgery but can lead to continued pain and increased rates of post-traumatic arthritis if there is the articular surface is not congruent. Calcaneus fractures are complex and difficult to manage, and the optimal treatment strategy must be tailored to the individual patient taking into account their clinical and social picture.