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: Keeper of the Arch

The spring ligament — formally the plantar calcaneonavicular ligament — is one of the most biomechanically important structures in the foot that most people have never heard of. It spans the gap between the calcaneus and navicular, directly supporting the talar head and forming the floor of the acetabulum pedis — the socket in which the talus rests. When this ligament fails, the arch collapses and the foot flattens, contributing significantly to adult-acquired flatfoot deformity.

At Balance Foot & Ankle in Howell and Bloomfield Township, Michigan, we identify spring ligament pathology as part of comprehensive flatfoot evaluation and address it in surgical reconstructions when indicated.

Anatomy and Function

The spring ligament has two main components: the superomedial spring ligament (the larger, clinically significant band) and the inferoplantar spring ligament. The superomedial band directly contacts the medial head of the talus, supporting it from below. It works in concert with the posterior tibial tendon — the tendon that actively lifts the arch — and the deltoid ligament complex. When either the tendon or the ligament fails, the other is placed at increased risk, creating a cascade of structural breakdown.

Causes of Spring Ligament Injury

Spring ligament injury most commonly occurs in association with posterior tibial tendon dysfunction (PTTD). As the posterior tibial tendon degenerates and loses its ability to actively support the arch, the spring ligament is subjected to progressively increasing static load until it eventually tears or attenuates. Acute spring ligament rupture can occur from a severe ankle eversion injury or fall. Inflammatory arthritis — particularly rheumatoid arthritis — can cause spring ligament attenuation through joint destruction. Obesity places chronic elevated load on this ligament, accelerating degeneration.

Clinical Presentation

Spring ligament injuries cause medial (inner) arch and ankle pain, progressive flatfoot deformity, difficulty with prolonged walking or standing, and “too many toes” sign when viewed from behind (excess toes visible due to forefoot abduction). MRI is the imaging modality of choice, identifying spring ligament tears, elongation, or signal change. The extent of spring ligament pathology significantly influences surgical planning — flatfoot reconstruction without addressing a torn spring ligament results in inferior outcomes.

Treatment

Conservative management — custom orthotics, physical therapy, boot immobilization — addresses symptoms of spring ligament insufficiency by providing external arch support while the tendon and ligament are optimally loaded. Surgical treatment of flatfoot deformity increasingly includes spring ligament reconstruction as a standard component of the repair, not just a secondary consideration. Spring ligament reconstruction typically uses the posterior tibial tendon sheath, allograft tissue, or synthetic augmentation to restore the ligament’s arch-supporting function. Combined with calcaneal osteotomy and FDL tendon transfer, spring ligament reconstruction has become integral to achieving durable flatfoot correction.

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Balance Foot & Ankle — Howell & Bloomfield Township, MI

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Spring Ligament Injury? Protecting the Foundation of Your Arch

The spring ligament is the critical support structure for your foot arch. When it fails, the arch collapses progressively. Dr. Tom Biernacki identifies spring ligament injuries early and provides treatment to prevent irreversible flat foot deformity.

Learn About Arch Support Treatment | Book Your Appointment | Call (810) 206-1402

Clinical References

1. Deland JT, et al. Posterior tibial tendon insufficiency: which ligaments are involved? Foot and Ankle International. 2005;26(6):427-435.
2. Rule J, et al. Spring ligament injuries. Foot and Ankle Clinics. 2017;22(3):519-527.
3. Tryfonidis M, et al. Imaging of the spring ligament with MRI. Foot and Ankle Surgery. 2009;15(1):14-19.

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Dr. Tom Biernacki, DPM

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Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.