The purpose of the present study was to evaluate the advantages and disadvantages of an endoscopic procedure for patients with symptomatic calcaneal bone cyst compared with an open procedure. The cases of 16 consecutive patients with a calcaneal bone cyst were reviewed. Of the 16 patients, 8 had undergone the open procedure (O group) from October 2003 to August 2011, and 8 had undergone the endoscopic procedure (E group) from September 2011 to April 2013. The endoscopic procedure used a 2-portal technique in which skin incisions were made to avoid the peroneal tendon according to the preoperative ultrasonography. All surgeries (open or endoscopic) consisted of curettage of the inner wall of the bone cyst, followed by injection of calcium phosphate cement. The following factors were evaluated: radiographic assessment, operative time, postoperative adverse effects, and interval to the return to sports. No significant difference between the 2 groups was observed in the operative time (53.5 ± 6.5 minutes in the O group and 56.1 ± 13.8 minutes in the E group). The E group experienced no adverse effects; however, the O group had 1 temporary irritation in the sural nerve area and 1 calcium phosphate cement leakage along the peroneal tendon sheath. The interval to a return to sports was significantly shorter in the E group (14.5 ± 0.9 weeks in the O group and 6.5 ± 1.1 weeks in the E group; p < .01). In conclusion, endoscopic surgery is a useful approach for the treatment of calcaneal bone cysts, allowing early rehabilitation and an early return to sports without any adverse effects.