Background: Intra-articular calcaneal fractures are debilitating injuries with significant implications for mobility and quality of life. The optimal treatment approach—operative vs. conservative—remains controversial. This study aims to compare functional outcomes between surgically and conservatively managed intra-articular calcaneal fractures. Methods: A prospective cohort study was conducted on 48 patients with intra-articular calcaneal fractures (24 operative, 24 conservative). Functional outcomes were assessed using the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale, Visual Analog Scale (VAS) for pain, and radiographic evaluation at 6- and 12-months post-treatment. Results: The operative group showed significantly better AOFAS scores (82.5 ± 8.2) compared to the conservative group (68.3 ± 10.4) at 12 months (p < 0.05). Pain scores (VAS) were lower in the operative group (2.1 ± 1.3) vs. conservative (4.5 ± 1.8) (p < 0.01). Complications included 3 surgical wound infections (12.5%) and 2 cases of subtalar arthritis in the conservative group (8.3%). Conclusion: Surgical management of intra-articular calcaneal fractures yields superior functional outcomes and reduced pain compared to conservative treatment, despite a higher risk of minor complications.

Calcaneal Fracture, Intra-Articular, Operative Treatment, Conservative Management, Functional Outcome