Our first 16 patients with intra-articular calcaneal fractures that were managed by open reduction and internal fixation were originally reviewed on average 3 years after operation. We looked at the same patients again on average more than 10 years after surgery using the same evaluation system by the same physician. Seventy-five percent of the patients showed an excellent or good functional result. In no case was there an indication for a secondary arthrodesis. In spite of the fact that radiologically most patients showed a slowly progressing posttraumatic subtalar osteoarthritis, the subjective results (pain, capacity to work, and/or sports) at 10 years were clearly better than 3 years after surgery. These results may allow the conclusion that radiologic findings are only of limited value in the assessment of long-term results after operative treatment of calcaneal fractures. From a functional point of view and on the long-term follow-up most patients with intra-articular fractures of the calcaneus seem to profit from open reduction and internal fixation.