Spring Ligament Anatomy, Injury, and Repair in Adult Flatfoot Reconstruction

Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

The spring ligament complex — formally the calcaneonavicular ligament complex — is the primary passive stabilizer of the talonavicular joint and the medial longitudinal arch. Historically underappreciated compared to the posterior tibial tendon, the spring ligament is increasingly recognized as a critical component of adult acquired flatfoot deformity (AAFD) — with disruption or attenuation of the spring ligament complex producing talonavicular instability that the posterior tibial tendon alone cannot compensate. Spring ligament repair has become a standard component of AAFD surgical reconstruction in recent years.

Anatomy: Three Components

The spring ligament complex consists of three distinct bundles: (1) the superomedial calcaneonavicular ligament (smCNL) — the largest and most clinically important bundle, running from the superomedial calcaneus to the navicular, directly supporting the talar head from below; (2) the medioplantar oblique ligament — running from the sustentaculum tali to the navicular beak; and (3) the inferoplantar longitudinal ligament — running from the anterior calcaneus to the navicular. The smCNL is the primary load-bearing component — it directly cushions the talar head during arch loading and its failure produces talar head uncovering (the radiographic hallmark of adult flatfoot).

Role in AAFD

MRI studies of adult acquired flatfoot demonstrate spring ligament attenuation or tear in 60–70% of Stage II PTTD cases — significantly higher than previously appreciated. The combination of posterior tibial tendon dysfunction AND spring ligament failure produces a more severe deformity than either condition alone, because the passive restraint at the talonavicular joint is lost simultaneously with the active dynamic restraint. Surgical repair of the spring ligament at the time of FDL tendon transfer and calcaneal osteotomy produces better radiographic correction and more durable outcomes than soft tissue procedures without spring ligament repair in comparative studies.

Repair Technique

Direct imbrication of the attenuated smCNL through the medial approach used for PTT surgery — plicating the ligament with multiple non-absorbable sutures under appropriate tension — is the standard technique. For complete spring ligament ruptures, reconstruction with FHL or gracilis graft augmentation is employed. The repair is protected for 6 weeks of non-weight-bearing identical to the protocol for the concurrent soft tissue procedures. Dr. Biernacki at Balance Foot & Ankle incorporates spring ligament assessment and repair into adult flatfoot reconstruction surgery. Call (810) 206-1402 at our Bloomfield Hills or Howell office for flatfoot surgical evaluation.

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When to See a Podiatrist

Many foot conditions can be managed conservatively at home, but some require professional evaluation. See a podiatrist promptly if you experience:

• Pain that persists for more than 2 weeks despite rest
• Swelling, redness, or warmth that isn’t improving
• Numbness, tingling, or burning in the feet
• A wound or sore that is not healing within 2 weeks
• Any foot concern if you have diabetes or poor circulation
• Nail changes that suggest fungal infection or other problems

At Balance Foot & Ankle, our three board-certified podiatrists — Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin — provide comprehensive foot and ankle care at our Howell and Bloomfield Township offices. Most insurance plans are accepted.

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Flatfoot Reconstruction Specialists in Michigan

The spring ligament is a critical stabilizer of the arch. When it fails, adult-acquired flatfoot progresses. Our surgeons perform advanced spring ligament repair as part of comprehensive flatfoot reconstruction.

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Clinical References

1. Deland JT, de Asla RJ, Sung IH, et al. Posterior tibial tendon insufficiency: which ligaments are involved? Foot Ankle Int. 2005;26(6):427-435.
2. Baxter JR, Demetracopoulos CA, Prado MP, et al. Lateral column lengthening corrects hindfoot valgus in a cadaveric flatfoot model. Foot Ankle Int. 2015;36(6):705-709.
3. Gazdag AR, Cracchiolo A III. Rupture of the posterior tibial tendon: evaluation of injury of the spring ligament and clinical assessment of tendon transfer and ligament repair. J Bone Joint Surg Am. 1997;79(5):675-681.

In-Office Treatment at Balance Foot & Ankle

If home care isn’t resolving your your foot or ankle concern, a visit with a board-certified podiatrist is the fastest path to accurate diagnosis and a personalized plan. At Balance Foot & Ankle Specialists, Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin offer same-day and next-day appointments at both our Howell and Bloomfield Hills offices. We perform on-site diagnostic ultrasound, digital X-ray, conservative care, advanced regenerative treatments, and minimally invasive surgery when indicated.

Call (810) 206-1402 or request an appointment online. Most insurance plans accepted, including Medicare, Blue Cross Blue Shield, Aetna, Cigna, and United Healthcare.

Differential Diagnosis: What Else Could It Be?

Several conditions share symptoms with Flat Feet (Pes Planus) and are commonly misdiagnosed in the first office visit. Considering these alternatives is part of every Balance Foot & Ankle exam:

• Posterior tibial tendon dysfunction (PTTD). Acquired adult flatfoot with single-leg heel-rise weakness.
• Tarsal coalition. Rigid flatfoot in an adolescent — bone bridge between hindfoot bones.
• Charcot foot (diabetic). Sudden warm, swollen, collapsing midfoot in a diabetic — urgent off-loading.

If your symptoms don’t fit the textbook pattern, ask your podiatrist which differentials they ruled out — that conversation often shortcuts months of trial-and-error treatment.

Most Common Mistake We See

The most common mistake we see is: Buying motion-control shoes without a gait assessment. Fix: get a pressure-plate analysis or wet-foot test first to confirm overpronation and arch height.

Warning Signs That Need Same-Day Care