A complete description of Ge growth on vicinal Si(001) surfaces in the angular miscut range 0 degrees -8 degrees is presented. The key role of substrate vicinality is clarified from the very early stages of Ge deposition up to the nucleation of 3D islands. By a systematic scanning tunneling microscopy investigation we are able to explain the competition between step-flow growth and 2D nucleation and the progressive elongation of the 3D islands along the miscut direction [110]. Using finite element calculations, we find a strict correlation between the morphological evolution and the energetic factors which govern the {105} faceting at atomic scale.