Abstract Objective To retrospectively analyze the clinical effects of tarsal sinus approach and arthroscopic minimally invasive approach in the treatment of Sanders type II/III calcaneal fractures. Methods From July 2015 to September 2018, 45 cases (52 feet) of calcaneal fracture were retrospectively analyzed. 24 cases (29 feet) in tarsal sinus group and 21 cases (23 feet) in arthroscopy group. X-ray and CT three-dimensional reconstruction of calcaneus were taken before operation. The VAS and AFAS scores and calcaneal imaging parameters such as length, width, height, Bohler angle, Gissane angle were measured. Results (1) There was no significant difference in preoperative indicators between the two groups (P > 0.05). (2) Operative time: The average time in arthroscopic group was 110.64 + 22.39 minutes, and that in tarsal sinus group was 47.92 + 15.63 minutes. There was significant difference between the two groups (t = 7.543, P < 0.01). (3) Postoperative Bohler angle, Gissane angle, calcaneal length, width and height in the two groups were better than those before operation, and the difference was significant (P < 0.01). (4) There were significant differences in Bohler angle, calcaneal length and width between the two groups at the 8th week after operation (P < 0.05). Arthroscopy group was superior to tarsal sinus group, but there was no significant difference in Gissane angle and calcaneal height between the two groups (P > 0.05). There was no significant difference in VAS and AOFAS scores between the two groups at the 2nd and 8th weeks after operation (P > 0.05). Conclusion This study shows that tarsal sinus approach and arthroscopy are effective and minimally invasive in the treatment of Sanders type II/III calcaneal fractures. Arthroscopy could significantly reduce incision complications and improve the quality of calcaneal reduction, but requires a longer learning curve.