Displaced intra-articular calcaneal fractures remain a difficult treatment problem because surgery can restore anatomy but may also create wound and soft-tissue complications. Long-term follow-up from the UK Heel Fracture Trial provides an important counterbalance to procedure-driven thinking. At five years, patients randomised to open reduction and internal fixation did not have better functional scores than those treated nonoperatively. Walking difficulty and shoe-wear outcomes were also similar. Importantly, the operative group underwent more additional surgical procedures. These results apply to selected closed, displaced intra-articular fractures without severe deformity causing fibular impingement or other major indications for surgery. The clinical implication is that anatomical restoration by ORIF does not automatically produce superior long-term function. For HCPs, treatment should therefore consider soft-tissue status, fracture morphology, patient expectations and the potential morbidity of surgery. ORIF can still be appropriate in selected cases where deformity threatens function or causes mechanical impingement, but the trial argues against routine fixation as a default strategy. Shared decision-making should include the possibility that conservative management may provide comparable long-term function with fewer operations.