Talar and calcaneal fractures arguably pose the biggest management challenge of all foot fractures. They are often associated with high energy mechanisms which can lead to significant comminution and soft tissue disruption. Coupled with their specific anatomical features, this unfortunately means that they are not infrequently associated with poor long-term outcomes relating to altered hindfoot/ankle function, deformity and post-traumatic arthrosis. Careful planning and execution of surgery is therefore imperative to maximise the likelihood of achieving an optimal outcome. Talar and calcaneal injuries often occur in distinct patterns and subtypes; classifications can be helpful, and recognition of these patterns is vital to determining an appropriate operative plan suitable for each fracture configuration. In this chapter we will outline these distinct patterns and pre-operative considerations to aid surgical planning and decision-making. We will also discuss the finer details of operative set up and relevant approaches, as well as various fixation strategies and post-operative protocols in line with current evidence and authors experience. In this way we hope to provide an algorithmic approach which can be modified ‘a la carte’ when faced with a range of injury scenarios to provide patient specific care.