Introduction: Posterior calcaneal exostosis treatment modalities showed many controversially opinions. After failure of the conservative treatment, surgical bursectomy and resection of the calcaneal exostosis are indicated by many authors. But clinical studies also show a high rate of unsatisfactory results with a relative high incidence of complications. The minimal surgical invasive technique by an endoscopic calcaneoplasty (ECP) could be an option to overcome some of these problems.

Material and Methods: We operate on 121 patients with an age range between 17–58 years, 60 males and 61 females. The radiologic examination prior to surgery documented in all cases a posterior superior calcaneal exostosis that showed friction to the achilles tendon. All patients included in the study had no clinical varus of the hind foot, nor cavus deformities. 108 patients had undergone a trial of conservative treatment for at least 6 months and did not show a positive response. The average follow-up was 45.2 months (12–96).

Results: According to the Ogilvie-Harris-Score 53 patients presented good and 55 patients excellent results, while 5 patients showed fair results, and 8 patients only poor results. All the post-operative radiographs showed sufficient resection of the calcaneal spur. Only minor postoperative complications were observed.

Conclusion: ECP is an effective and of minimal-invasive procedure for the treatment of patients with calcaneal exostosis. After a short learning curve the endoscopic exposure is superior to the open technique has less morbidity, less operating time, and nearly no complications, moreover the pathology can better be differentiated.