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) . Some authors describe a third portion of the spring ligament, with fibers extending from the notch between the calcaneal facets to the navicular tuberosity . 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 . Pathology of the spring ligament is extremely common in patients with posterior tibial tendon insufficiency (Fig. 17) . 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 . Spring ligament reconstruction has been shown to be effective in correction of acquired flatfoot deformity , and in improving gait function .
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 . 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 . Additionally, surgical release of the lateral band of the plantar fascia has been found to place increased tension on the bifurcate ligament .
Fig. 17. Coronal FSE image demonstrates normal superomedial fibers of the spring ligament, which act as a "sling" for the head of the talus.
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