Open calcaneal fractures can be managed with an array of treatment techniques and result in a wide range of outcomes. Due to the fracture's relative obscurity, the optimal form of intervention remains controversial. Consequently, treatment for these hindfoot fracture-disruptions continues to evolve. Timing of intervention may be a key factor in decreasing complication rates. The goals of open calcaneal fracture management include timely healing of the soft-tissue envelope without infection and maintenance of bony alignment. Unfortunately, restoration of joint congruence may be impossible. Unsatisfactory outcomes may result from neurogenic pain, infection, malunion, arthrosis, and bony impingement. Future advancements in treatment are anticipated and will depend on an improved understanding of this devastating orthopedic injury.