Spring ligament: Medial Ankle Ligamentous Complex Anatomy, Injuries, and Treatment

The spring ligament complex, also known as the plantar calcaneonavicular ligament, is a thick connective tissue that supports the foot’s inner arch (medial longitudinal). The spring ligament, posterior tibial tendon, and deltoid ligament all support the medial foot and ankle. The spring ligament stores and releases energy as the foot and ankle absorbs impact forces during gait. Thus, it’s referred to as the spring ligament or spring ligament complex, even though the tissue consists of fibrocartilage (very stiff) rather than elastic fibers. (no spring)

Anatomy

The spring ligament comprises three ligaments connecting the sustentaculum tali (calcaneus) to the navicular bone’s plantar (bottom) side.
The three ligaments are:

  • Superomedial ligament- talus head support with a fibrocartilaginous facet
  • Medioplantar oblique ligament
  • Inferior calcaneonavicular ligament

The medioplantar oblique ligament and the inferior calcaneonavicular ligament are on the plantar surface and blend in with the Tibialis posterior tendon and deltoid ligament to support the medial foot and ankle.

Injuries

Acute spring ligament complex tears lead to flat foot deformity and dysfunction of the posterior tibial tendon. Spring ligament tears cause the head of the talus to collapse, straining the calcaneounavicular ligament and eventually total collapse of the medial longitudinal arch. Tibial nerve pain and neuropathy can also occur due to the increased load on the inner foot.

Treatment

  • Posterior tibial nerve flossing
  • Foot intrinsic exercises
  • Posterior tibial tendon pumping
  • Address ankle dorsiflexion limitations
  • Big toe normalization- Restore full range of motion (extension) to engage windlass mechanism
  • Strengthening exercises for primary arch stabilizers including tibialis posterior, peroneal longus, and tibias anterior.

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