Abstract
OBJECTIVE: To review the pathological characteristics of calcaneal fracture malunions and the research progress of surgical treatment, so as to provide a reference for standardized clinical diagnosis and treatment. METHODS: The relevant research literature on calcaneal fracture malunions at home and abroad in recent years was reviewed. The pathological characteristics, imaging manifestations, classification, and the latest surgical treatment strategies of calcaneal fracture malunions were systematically expounded. RESULTS: Malunion may ensue after calcaneal fractures if conservative treatment fails or surgical intervention is improperly performed, leading to abnormal foot biomechanics and severe functional impairment. Typical pathological changes include three-dimensional morphological disorders of the calcaneus (abnormal width, height loss, and varus-valgus deformity), collapse of the subtalar articular surface accompanied by joint mismatch, secondary joint degeneration, Achilles tendon contracture, and lateral soft tissue impingement syndrome. Given the complex pathological anatomy after malunion, surgical plans should be individually tailored. The clinically used Stephens-Sanders classification and Zwipp-Rammelt classification provide a reliable basis for the accurate selection of treatment modalities. Staged treatments such as subtalar arthrodesis, osteotomy correction, and soft tissue release can effectively improve ankle and foot function. CONCLUSION: In recent years, the biomechanical mechanisms, imaging evaluation systems, and reconstructive surgical strategies of calcaneal fracture malunion have become research hotspots. The selection of treatment plans should take into account specific clinical symptoms and morphological changes of the calcaneus, which is crucial for subsequent recovery. In the future, it is necessary to focus on individual differences, promote the integration of diagnosis and treatment, establish evidence-based guidelines, and achieve accurate and long-term deformity correction and functional reconstruction.