Spring And Bifurcate Ligaments

The spring ligament is composed of the superomedial calcaneonavicular ligament and the inferior calcaneonavicular ligament, and functions as a ''sling'' for the head of the talus (Fig. 16) [37]. Some authors describe a third portion of the spring ligament, with fibers extending from the notch between the calcaneal facets to the navicular tuberosity [44]. The deltoid ligament and posterior tibial tendon have direct attachments to the spring ligament [35-37]. The super-omedial calcaneonavicular ligament has a load-bearing function, while that of the inferior calcaneonavicular ligament is primarily tensile [37]. Pathology of the spring ligament is extremely common in patients with posterior tibial tendon insufficiency (Fig. 17) [45]. Surgical reconstruction of the spring ligament is often performed in conjunction with repair of the posterior tibial tendon, typically by using a tendon graft from the peroneus longus [46]. Spring ligament reconstruction has been shown to be effective in correction of acquired flatfoot deformity [46], and in improving gait function [47].

Talar Stress Fracture
Fig. 16. Coronal FSE image demonstrates scarring of the deep fibers of the deltoid ligament and an ossific fragment abutting and causing mass effect on the medial talus. (Courtesy of Department of MRI, Hospital for Special Surgery, New York, NY.)

The bifurcate ligament extends from the anterior process of the calcaneus to both the navicular and the cuboid (Fig. 18), and is tight on inversion, or inversion with plantarflexion [48]. Inversion injury is occasionally accompanied by an avulsion fracture of the anterior process of the calcaneus, at the insertion of the bifurcate ligament [49,50]. This injury can be radiographically and clinically subtle [50]. Additionally, surgical release of the lateral band of the plantar fascia has been found to place increased tension on the bifurcate ligament [51].

Spring Ligament Espa

Fig. 17. Coronal FSE image demonstrates normal superomedial fibers of the spring ligament, which act as a "sling" for the head of the talus.

Spring Ligament
Fig. 18. Coronal (A) and axial (ß) images demonstrate degeneration of both the superome-dial (A) and inferior (ß) fibers of the spring ligament in a patient with acquired flatfoot deformity. (Courtesy of Department of MRI, Hospital for Special Surgery, New York, NY.)
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  • kaiju
    Is the spring ligament a bifarcated ligament?
    6 years ago

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