Spring Ligament Repair and Reconstruction: Restoring the Foot’s Medial Arch Support

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

What Is the Spring Ligament?

The spring ligament — more formally called the plantar calcaneonavicular ligament complex — is a critical static stabilizer of the medial longitudinal arch, connecting the calcaneus to the navicular bone on the plantar-medial side of the hindfoot. It supports the head of the talus from below, preventing it from plantarflexing and medially deviating — the motion that causes arch collapse and hindfoot valgus in adult-acquired flatfoot.

The spring ligament complex has three components: the superomedial calcaneonavicular ligament (the largest and most clinically important), the inferoplantar ligament, and the third (inferior) component. Along with the posterior tibial tendon and the plantar fascia, the spring ligament forms the primary static support of the medial arch.

At Balance Foot & Ankle in Howell and Bloomfield Township, Michigan, spring ligament pathology is evaluated as part of every comprehensive adult flatfoot assessment, as it is now recognized as a key contributor to progressive arch collapse that must be addressed in surgical flatfoot reconstruction.

Spring Ligament Injury and Pathology

The spring ligament is frequently torn or attenuated (stretched and thinned) in patients with adult-acquired flatfoot deformity related to posterior tibial tendon dysfunction (PTTD). In fact, spring ligament deficiency may be as important as — or even more important than — posterior tibial tendon dysfunction in driving progressive arch collapse in some patients. MRI studies of adult flatfoot regularly demonstrate spring ligament tears, fraying, or attenuation, particularly of the superomedial component.

Spring ligament tears can also occur acutely from high-energy ankle injuries, though this is less common than the chronic attritional tearing associated with progressive flatfoot.

Why Spring Ligament Status Matters for Surgical Planning

Historically, flatfoot reconstruction surgery focused primarily on the posterior tibial tendon (tendon transfer) and bony correction (calcaneal osteotomy, subtalar fusion). However, outcomes were compromised in patients with significant spring ligament deficiency, because the dynamic tendon transfer and bony correction could not compensate for the absent static ligamentous arch support. Recognition of spring ligament pathology as an independent contributor has led to its routine inclusion in modern flatfoot reconstruction protocols.

Surgical Repair and Reconstruction Techniques

Primary Spring Ligament Repair

When residual ligament tissue is of adequate quality, primary repair with non-absorbable sutures — sometimes reinforced with suture tape augmentation — can restore ligament continuity and tension. This is most often feasible in earlier-stage disease before significant ligament degeneration has occurred.

Spring Ligament Reconstruction

For patients with severely attenuated or absent spring ligament tissue, reconstruction using tendon graft is required. Graft options include the flexor digitorum longus (FDL) tendon harvested from the plantar foot, gracilis tendon allograft, or peroneus longus tendon (when transfer is planned). The graft is routed to recreate the superomedial spring ligament component, restoring the support sling beneath the talar head.

Internal Brace Augmentation

Suture tape augmentation — creating an internal brace using high-strength suture tape anchored between the calcaneus and navicular — reinforces spring ligament repair or reconstruction and reduces stress on the repair during the healing period. This technique has been adapted from ankle ligament reconstruction and shows promising early results in flatfoot reconstruction series.

Outcomes and Context in Flatfoot Reconstruction

Spring ligament repair or reconstruction is performed as part of a comprehensive flatfoot reconstruction that typically also includes posterior tibial tendon debridement or transfer (FDL transfer), calcaneal osteotomy to correct heel valgus, and occasionally first tarsometatarsal stabilization (Lapidus) or Cotton osteotomy for forefoot abduction. Addressing all components of the deformity — bony alignment, tendon support, and ligamentous stability — provides the most durable long-term correction.

If you have been diagnosed with adult-acquired flatfoot or PTTD and are considering surgical reconstruction, a comprehensive evaluation by a foot and ankle surgeon experienced in flatfoot reconstruction — including assessment of spring ligament integrity by MRI — ensures that all contributing factors are identified and addressed. Contact Balance Foot & Ankle at our Howell or Bloomfield Township office for a surgical consultation.

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Spring Ligament Repair & Flatfoot Reconstruction

The spring ligament (calcaneonavicular ligament) is a critical arch support structure that often fails in advanced flatfoot deformity. At Balance Foot & Ankle, Dr. Tom Biernacki performs spring ligament repair and reconstruction as part of comprehensive flatfoot correction surgery.

Learn About Our Flatfoot Reconstruction Options → | Book Your Appointment | Call (810) 206-1402

Clinical References

1. Deland JT, et al. Spring ligament failure is a major cause of adult-acquired flatfoot deformity. Foot Ankle Int. 2005;26(11):927-935.
2. Williams BR, et al. Spring ligament repair and reconstruction. Tech Foot Ankle Surg. 2011;10(3):125-132.
3. Baxter JR, et al. Biomechanical assessment of the spring ligament complex. Foot Ankle Int. 2021;42(3):334-340.