Introduction: There is still debate on the effect of operative treatment on severe displaced intra-articular fractures of the os calcis. Operatively treatment consists of open reduction or percutanious screw fixation, with conflicting results. Although the results of either operative treatment are published, little is known about the long term results of non-surgical treatment of these difficult fractures.

Patients and Methods: We analyzed the data of 35 patients with an intra-articular fracture of the oc calcis which were treated with a plaster cast between 1994 and 2006. All radiographs of the fracture and the radiograph at the latest follow-up were analyzed. All patients which could be traced were invited for a clinical examination and a radiograph. A Foot Function Index-score (FFI) and AOFAS score were recorded as clinical outcome. A regression analysis was performed with the clinical outcome (AOFAS score and FFI) as outcome and age, gender, Bohler’s and Gissane’s angles, trauma mechanism and type of fracture as predictors.

Results: After a median follow-up of 10 years the mean AOFAS score was 75.8 (range29–100) and the FFI was 22.9 (range 0–71). In the regression analysis we found that none of the predictors could predict the outcome. Even the Bohler’s and Gisae angle did not predict the clinical outcome. Although there was a strong correlation between the Bohler’s angle on the lateral radiograph and the occurrence of degenerative changes in the long term follow-up, both Bohler’s angle and the degenerative changes did not correlate with the clinical measures.

Conclusion: Although Bohler’s angle is a strong predictor for degenerative changes after a calcaneal fracture, both Bohler’s angle and the degenerative changes on the radiograph were not correlated with the clinical outcome.