Spring Ligament Injury

Last updated: February 8, 2026Reviewed date: February 8, 2026Reading time: 5 min read
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Spring ligament complex injuries or calcaneonavicular ligament injuries refer to stretching sprains, tears, or ruptures of the plantar calcaneonavicular ligament complex and can affect one or more of the three portions. Since spring ligament repair is often combined with a flatfoot reconstruction, recovery involves typically six weeks of non-weightbearing then...

For severe symptoms, danger signs, pregnancy, child illness, or sudden worsening, seek urgent medical care.

বাংলা রোগী নোট এখনো যোগ করা হয়নি। পোস্ট এডিটরে “RX Bangla Patient Mode” বক্স থেকে সহজ বাংলা সারাংশ যোগ করুন।

এই তথ্য শিক্ষা ও সচেতনতার জন্য। এটি ডাক্তারি পরীক্ষা, রোগ নির্ণয় বা প্রেসক্রিপশনের বিকল্প নয়।

Article Summary

Spring ligament complex injuries or calcaneonavicular ligament injuries refer to stretching sprains, tears, or ruptures of the plantar calcaneonavicular ligament complex and can affect one or more of the three portions. Since spring ligament repair is often combined with a flatfoot reconstruction, recovery involves typically six weeks of non-weightbearing then a walking boot. Physical therapy is required for optimal results, and recovery can take up to 9-12 months. A spring...

Key Takeaways

  • This article explains Causes in simple medical language.
  • This article explains Differential Diagnosis in simple medical language.
  • This article explains Diagnosis in simple medical language.
  • This article explains Classification in simple medical language.
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Emergency safety firstUrgent warning signs are highlighted below.

Seek urgent medical care if you notice

These warning signs are general safety guidance. Local emergency numbers and clinical judgment should always come first.

  • Severe symptoms, breathing difficulty, fainting, confusion, or rapidly worsening illness.
  • New weakness, severe pain, high fever, or symptoms after a serious injury.
  • Any symptom that feels urgent, unusual, or unsafe for the patient.
1

Emergency now

Use emergency care for severe, sudden, rapidly worsening, or life-threatening symptoms.

2

See a doctor

Book a professional medical evaluation if symptoms persist, worsen, recur often, affect daily activities, or occur in a high-risk patient.

3

Learn safely

Use this article to understand possible causes, tests, treatment options, prevention, and questions to ask your clinician.

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Definition

Spring ligament complex injuries or calcaneonavicular ligament injuries refer to stretching sprains, tears, or ruptures of the plantar calcaneonavicular ligament complex and can affect one or more of the three portions. Since spring ligament repair is often combined with a flatfoot reconstruction, recovery involves typically six weeks of non-weightbearing then a walking boot. Physical therapy is required for optimal results, and recovery can take up to 9-12 months.

A spring ligament injury refers to stretching, partial or complete tear of the spring ligament complex that acts as a static stabilizer of the medial longitudinal arch. It can affect one or more of the following ligamentous portions 1–3: superomedial calcaneonavicular ligament (clinically most relevant). Spring ligament complex injuries are most commonly associated with posterior tibial tendon dysfunction and are rare in isolation. Middle-aged women are most commonly affected.

The plantar calcaneonavicular ligament also referred to as the spring ligament is a thick wide band of cartilaginous connective tissue that supports the medial longitudinal arch of the foot, failure in the spring ligament leads to flat foot deformity. The spring ligament despite its name does not possess spring-like properties as it is highly collagenous.

  • General
    • Overall rare diseases are poorly described in the literature
    • Can be acute and seen in athletes
    • The chronic, degenerative form is often seen along with Posterior Tibial Tendon Dysfunction

Causes

  • Chronic
    • Most of the literature discusses chronic degenerative changes
    • Associated with Posterior Tibial Tendon Dysfunction
  • Acute
    • Associated with running and jumping sports
    • Often results from an abduction or eversion type mechanism during sports
    • An awkward landing from a fall can also injure the spring ligament
    • Many athletes have an unclear mechanism of injury and describe a sprain injury.

Associated Conditions

  • Posterior Tibial Tendon Dysfunction
  • Deltoid Ligament Injury
  • Chopart Complex Injury

Pathoanatomy

  • Spring Ligament Complex
    • Originates on the calcaneus, inserts into the navicular
    • Consists of
      • Superomedial calcaneonavicular ligament (SmCNL)
      • Medioplantar oblique calcaneonavicular ligament (MpoCNL)
      • Inferoplantar longitudinal calcaneonavicular ligament (IplCNL)
    • Function: stabilize the talonavicular joint, longitudinal arch of the foot
      • In conjunction with posterior tibial tendon
  • Sports (case reports only)
    • Track and Field
      • Pole Vaulting[3]
      • Jumper[4]
    • Soccer
    • Cricket
    • Tennis[5]
    • Hiking[6]

diagnosis: Differential diagnosis is a list of possible conditions that may explain symptoms. সহজ বাংলা: একই লক্ষণের সম্ভাব্য রোগের তালিকা।" data-rx-term="differential diagnosis" data-rx-definition="Differential diagnosis is a list of possible conditions that may explain symptoms. সহজ বাংলা: একই লক্ষণের সম্ভাব্য রোগের তালিকা।">Differential Diagnosis

  • Fractures & Osseous Disease
    • Traumatic/ Acute
      • Talus Fracture
      • Calcaneus Fracture
      • Traumatic Navicular Fracture
      • Cuboid Fracture
      • Cuneiform Fracture
      • Metatarsal Fracture
        • Fifth Metatarsal Fracture
      • Toe Fracture
      • Hallux Sesamoid Fracture
    • Stress Fractures
      • Navicular Stress Fracture
      • Metatarsal Stress Fracture
    • Other Osseous
      • Tarsal Coalition
      • Accessory Navicular Syndrome
  • Dislocations & Subluxations
    • Toe Dislocation
    • Lisfranc Injury
    • Chopart Complex Injury
    • Cuboid Syndrome
  • Muscle and Tendon Injuries
    • Posterior Tibial Tendon Dysfunction
    • Peroneal Tendonitis
    • Tibialis Anterior Tendinopathy
    • Flexor Hallucis Longus Tendinopathy
  • Ligament Injuries
    • Plantar Fasciopathy (Plantar Fasciitis)
    • Turf Toe
    • Plantar Plate Tear
    • Spring Ligament Injury
  • Neuropathies
    • Mortons Neuroma
    • Tarsal Tunnel Syndrome
    • Joggers Foot (Medial Plantar Nerve)
    • Baxters Neuropathy (Lateral Plantar Nerve)
  • Arthropathies
    • Hallux Rigidus (1st MTPJ OA)
    • Gout
  • Toenail
    • Subungual Hematoma
    • Subungual Exostosis
    • Nail Bed Laceration
    • Onychocryptosis (Ingrown Toenail)
    • Onychodystrophy
    • Paronychia
    • Onychomycosis
  • Pediatrics
    • Fifth Metatarsal Apophysitis (Iselin’s Disease)
    • Calcaneal Apophysitis (Sever’s Disease)
    • Freibergs Disease (Avascular Necrosis of the Metatarsal Head)

Diagnosis

  • History
    • Inability to bear weight immediately following injury may correlate to the degree or severity of the injury
    • Pain along arch extending towards medial malleolus and retromalleolus
    • Some patients may have lateral pain, an impingement in the sinus tarsi region[7]
    • Patients may report early vague activity-related medial ankle and foot pain, difficulties walking on uneven ground, and/or balance problems
  • Physical Exam: Physical Exam Foot
    • Medial arch swelling, tenderness is typically present
    • The tenderness between the sustentaculum tali and the navicular
  • Special Tests
    • Too Many Toes Sign: Too many toes seen on the affected limb from posterior evaluation
    • Single Limb Heel Rise: The patient performs a single-limb heel raise

Radiographs

  • Standard Radiographs Foot
    • Useful to exclude evidence of deltoid injury
  • Potential findings
    • Abduction and uncoverage of the talonavicular joint
    • Loss of the medial longitudinal arch
    • Dorsal subluxation of the navicular
  • Meary’s Angle[8]
    • Lateral talo-1st metatarsal angle is used to assess flatfoot deformity
    • Normal: lateral talo-1st metatarsal angle less than 4°
    • Abnormal: large angle often indicates flatfoot deformity

MRI

  • Gold standard diagnostic imaging modality
  • Useful to evaluate
    • Spring Ligament
    • Posterior Tibial Tendon
  • Findings
    • Edema of navicular, talar head
  • Findings for superomedial calcaneonavicular ligament (SmCNL)[9]
    • Best seen on axial and coronal cuts
    • Abnormally high signal intensity on T2-weighted or proton density (PD) images
    • Thickening (>5–6 mm), thinning (<2 mm), waviness, and discontinuity
  • ICN Bundle
    • Best seen on axial and coronal images
    • Intermediate signal intensity on T1, low intensity on T2 images
  • MPO bundle
    • Harder to visualize
    • Has a striated appearance on the axial and coronal images
  • Diagnostic accuracy[9]
    • Sensitivity: 55%
    • Specificity: 100%

Ultrasound

  • Utility
    • Visualize the superior medial bundle
    • Can indicate disruption or thickening of the ligament fibers
    • Allows visualization of the distal aspect of the posterior tibialis tendon

Classification

Gazdag and Cracchiolo Classification

  • General[10]
    • Describes spring ligament disease in the setting of posterior tibial tendon dysfunction
    • Currently, no classification system exists for isolated spring ligament injury
  • Grade 1
    • Longitudinal tear within the midsubstance
    • OR partial tears at the ligament’s insertion on the sustentaculum tali or the navicular
    • OR a single longitudinal tear or several small tears at the ligament insertion.
    • No apparent ligamentous laxity
  • Grade 2
    • Loose ligament that appears stretched, with or without visible tears
  • Grade 3
    • Complete rupture of the ligament.

Management

Nonoperative

  • Indications
    • First-line treatment for the vast majority of cases
    • Partial injury without arch collapse or pes planus
  • RICE Therapy initially
  • Immobilization/ Protection
    • Individuals should be in Short Walking Boot with non-weight-bearing status (NWB) until a definitive diagnosis is made[11]
    • Once a diagnosis is confirmed, NWB status should be maintained for 6 weeks
    • Subsequently, a patient can be weened out of boot over 3-4 weeks
    • As the patient is weaned, a custom Orthotic Arch Support should be prescribed
  • Weight-bearing status
    • Most patients should be NWB for about 6 weeks
    • Following this, they can initiate weightbearing progression along with physical therapy
  • Physical Therapy

Operative

  • Indications
    • Complete tear of the ligament complex
    • Resultant foot deformity
    • Consider in all young or competitive athletes
  • Technique
    • Spring Ligament Reconstruction
    • Spring Ligament Repair
    • Posterior Tibial Tendon as indicated
Doctor visit helper

Prepare before seeing a doctor

A simple rural-patient checklist to help you explain symptoms clearly, ask better questions, and avoid unsafe self-treatment.

Safety note: This is not a prescription or diagnosis. For severe symptoms, pregnancy danger signs, children with serious illness, chest pain, breathing difficulty, stroke-like weakness, or major injury, seek urgent care.

Which doctor may help?

Start with a registered doctor or the nearest qualified health center.

What to tell the doctor

  • Write when the problem started and how it changed.
  • Bring old prescriptions, investigation reports, and current medicines.
  • Write allergies, pregnancy status, diabetes, kidney/liver disease, and major past illnesses.
  • Bring one family member if the patient is weak, elderly, confused, or a child.

Questions to ask

  • What is the most likely cause of my symptoms?
  • Which danger signs mean I should go to hospital quickly?
  • Which tests are necessary now, and which can wait?
  • How should I take medicines safely and what side effects should I watch for?
  • When should I come for follow-up?

Tests to discuss

  • Vital signs: temperature, pulse, blood pressure, oxygen saturation
  • Basic physical examination by a clinician
  • CBC, urine test, blood sugar, or imaging only when clinically needed

Avoid these mistakes

  • Do not use antibiotics, steroid tablets/injections, or strong painkillers without proper medical advice.
  • Do not hide pregnancy, kidney disease, ulcer, allergy, or blood thinner use.
  • Do not delay emergency care when danger signs are present.

Medicine safety and first-aid guide

This section is for patient education only. It does not replace a doctor, pharmacist, or emergency care.

Safe first steps

  • Avoid heavy lifting, sudden bending, and prolonged bed rest.
  • Use comfortable posture and gentle movement as tolerated.
  • Discuss physiotherapy, X-ray, or MRI only when clinically needed.

OTC medicine safety

  • For mild back pain, pain-relief medicine may be discussed with a doctor or pharmacist.
  • Avoid repeated painkiller use if you have kidney disease, stomach ulcer, uncontrolled blood pressure, or are taking blood thinners.

Avoid these mistakes

  • Do not start antibiotics without a proper medical decision.
  • Do not use steroid tablets or injections casually for quick relief.
  • Do not delay emergency care because of home remedies.

Get urgent help if

  • Back pain with leg weakness, numbness around private area, loss of urine/stool control, fever, cancer history, or major injury needs urgent care.
Medicine names, dose, and timing must be decided by a qualified clinician or pharmacist after checking age, pregnancy, allergy, other diseases, and current medicines.

For rural patients and family caregivers

Patient health record and symptom diary

Write your symptoms, medicines already taken, test results, and questions before visiting a doctor. This note stays on your device unless you print or copy it.

Doctor to discuss: Doctor / qualified healthcare provider
Tests to discuss with doctor
  • Basic vital signs: temperature, pulse, blood pressure, oxygen level if needed
  • Relevant blood, urine, imaging, or specialist tests only after clinical assessment
Questions to ask
  • What is the most likely cause of my symptoms?
  • Which warning signs mean I should go to emergency care?
  • Which tests are really needed now?
  • Which medicines are safe for my age, pregnancy status, allergy, kidney/liver/stomach condition, and current medicines?

Emergency warning signs such as chest pain, severe breathing difficulty, sudden weakness, confusion, severe dehydration, major injury, or loss of bladder/bowel control need urgent medical care. Do not wait for online information.

Safe pathway to proper treatment

Care roadmap for: Spring Ligament Injury

Use this simple roadmap to understand the next safe steps. It is educational and does not replace examination by a doctor.

Go to emergency care if you notice:
  • Severe or rapidly worsening symptoms
  • Breathing difficulty, chest pain, fainting, confusion, severe weakness, major injury, or severe dehydration
Doctor / service to discuss: Qualified healthcare provider; specialist depends on symptoms and examination.
  1. Step 1

    Check danger signs first

    If danger signs are present, seek emergency care and do not wait for online information.

  2. Step 2

    Record the symptom story

    Write when symptoms started, severity, medicines already taken, allergies, pregnancy status, and test results.

  3. Step 3

    Visit a qualified clinician

    A doctor, nurse, or qualified healthcare provider can examine you and decide which tests or treatment are needed.

  4. Step 4

    Do only useful tests

    Do tests after clinical assessment. Avoid unnecessary tests, random antibiotics, or repeated medicines without diagnosis.

  5. Step 5

    Follow up and return early if worse

    If symptoms worsen, new warning signs appear, or treatment is not helping, return for review quickly.

Rural patient practical tips
  • Take a written symptom diary and all previous prescriptions/test reports.
  • Do not hide medicines already taken, even herbal or over-the-counter medicines.
  • Ask which warning signs mean urgent referral to hospital.

This roadmap is for education. A real diagnosis and treatment plan requires history, examination, and clinical judgment.

RX Patient Help

Ask a health question safely

Write your symptom story. A health professional or site editor can review it before any answer is prepared. This box is not for emergency care.

Emergency first: Severe chest pain, breathing trouble, unconsciousness, stroke signs, severe injury, heavy bleeding, or rapidly worsening symptoms need urgent local medical care now.

Frequently Asked Questions

Is this article a replacement for a doctor?

No. It is educational content only. Patients should consult a qualified clinician for diagnosis and treatment.

When should I seek urgent care?

Seek urgent care for severe symptoms, rapidly worsening condition, breathing difficulty, severe pain, neurological changes, or any emergency warning sign.

References

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