Abstract Objects To study the effect of ultrasound-assisted localization on the location of screws in the process of calcaneus fracture treated by tarsal sinus approach. Methods From February 2015 to May 2018, 47 patients (52 feet) with calcaneal fractures met the inclusion criteria were randomly divided into control group (23 cases, 25 feet). C-arm fluoroscopy was used to locate the talus process screw in operation. The observation group (24 cases, 27 feet) was used to locate the talus process by ultrasound before operation. The talus process screw was disposed of by a guide device from the lateral wall plate during operation. Results (1)The talus process is located 7-12 cm below the medial malleolus tip and 38-42 mm behind the talus-navicular joint gap. The length of the long axis is 21.47±3.72 mm, the width is 9.31±1.84 mm, the upper boundary is 2.9-5.7 mm from the posterior tibial tendon, and the lower boundary is 1.7-3.2 mm from the posterior tibial artery. (2) There were significant differences in operative time and fluoroscopy frequency between the two groups (p < 0.01). (3)There were significant differences in Bohler angle, Gissane angle and AOFAS score between the two groups one year after operation (p < 0.05). Conclusion Preoperative ultrasound localization of the surface projection range of the tarsal process can not only more accurately implant the tarsal process screw, but also shorten the operation time and the number of intraoperative fluoroscopy, avoid the injury of tendons and blood vessels caused by medial auxiliary incision or blind area of screw placement, and make the operation of calcaneal fracture more minimally invasive and safe.