Abstract： Objective To compare the efficacy of a small incision for tarsal sinus approach versus an L-shape incision on the lateral approach for calcaneal fracture and their influence on recovery of foot function.Methods A total of 88 patients with calcaneal fractures admitted to our hospital from October 2020 to October 2022 were recruited.They were assigned into the control group(n=43)and study group(n=45)according to surgical methods.An L-shape incision on the lateral approach was adopted in the control group,and a small incision for tarsal sinus approach was used in the study group.The operation conditions and complications,foot function,calcaneal anatomical structure,bone metabolism,inflammatory factors and stress response were compared between groups.Results Compared with those of the control group,patients in the study group had significantly less postoperative drainage volume and intraoperative blood loss,and shorter operation time,length of stay and fracture healing time,and lower complication rate(P＜0.05).Compared with pre-operation levels,the American Orthopaedic Foot and Ankle Society(AOFAS)score,Bohler angle,Gissane angle,calcaneal length,calcaneal height,Procollagen Type I Intact N-terminal Propeptide(P1NP)and bone alkaline phosphatase(BALP)levels were significantly elevated at 3 months postoperatively in both groups,which were significantly higher in the study group than in the control group(P＜0.05).Tartrate-resistant acid phosphatase(TRAP)and cyclophosphamide(CTX)were significantly reduced at 3 months postoperatively than preoperative levels,and they were significantly lower in the study group than control group(P＜0.05).Compared with the pre-operation levels,C-reactive protein(CRP),interleukin 6(IL-6)and malondialdehyde(MDA)at 3 days postoperatively were significantly elevated,which were significantly lower in the study group than those of control group(P＜0.05).Superoxide dismutase(SOD)level at 3 days postoperatively was significantly lower than preoperative level,and it was significantly higher in the study group than the control group(P＜0.05).Conclusion The effect of a small incision for tarsal sinus approach on the treatment of calcaneal fracture is ideal,which can reduce surgical trauma,inflammation and stress response,and promote the recovery of postoperative foot function and bone metabolism,with fewer complications.