Even with greater emphasis on anatomic reduction, outcomes after calcaneal fractures continue to be unsatisfactory in many patients. Lateral wall impingement, subtalar arthrosis with pain and stiffness, nerve compression syndromes, and hindfoot malalignment all can cause disabling symptoms. If conservative treatment fails to relieve symptoms, subtalar arthrodesis can provide a painless, stable hindfoot in most patients. For severe deformity with anterior ankle impingement and loss of the talar angle of declination, distraction bone block arthrodesis through a posterior approach is preferred.