Background: Displaced extra-articular tongue-type calcaneal body fractures are complex injuries that significantly impair foot function and quality of life. Traditional open surgical techniques pose risks such as wound infection and prolonged recovery, necessitating less invasive alternatives. Objective: This study aims to evaluate the efficacy, outcomes, and complications of managing these fractures with minimally invasive cortical compression screws, enhancing recovery and mobility. Methods: Between September 2015 and April 2016, 165 patients with displaced extra-articular tongue-type calcaneal fractures were randomly assigned to two treatment groups: the minimally invasive longitudinal approach (MILA) and the sinus tarsi approach (STA). Postoperative outcomes, including complication rates, functional assessments using AOFAS scores, and radiographic evaluations, were analyzed. Results: The MILA group demonstrated shorter operative times (45.9 minutes) and lower wound-healing complications (2.9%) compared to the STA group (61.9 minutes and 12.5%, respectively). Both groups had comparable functional outcomes for Type II and III fractures, but the STA group showed significantly better results for Type IV fractures (56.3% vs. 14.3%, P = 0.017). Conclusion: Both MILA and STA are effective for treating displaced extra-articular tongue-type calcaneal fractures, with MILA offering advantages in operative efficiency and lower complications for less severe fractures. However, STA is preferred for complex fractures due to superior anatomical reduction and functional outcomes. This supports a tailored approach in surgical technique selection based on fracture severity.