The spring ligament, also known as the plantar calcaneonavicular ligament, is a key structure supporting the foot’s medial arch. It connects the heel bone (calcaneus) to the navicular and works alongside the posterior tibial tendon to maintain the arch. A spring ligament sprain or tear can cause significant pain, loss of function, and, in some cases, a flatfoot deformity. So what is a spring ligament sprain, and how do we treat it?
Causes of a spring ligament injury
A spring ligament injury can result from both acute trauma and overuse.
Acute injuries — a sudden twist or an awkward landing — can stretch or tear the ligament. Athletes in sports involving jumping, pivoting, or running on uneven surfaces are at higher risk.
Overuse can also cause a slow breakdown of the ligament, especially in high-impact activities such as long-distance running and gymnastics. People with posterior tibial tendonitis or excessive pronation are particularly susceptible, as both place extra strain on the inner ankle. In fact, most chronic spring ligament injuries are associated with posterior tibial tendon disease.
Spring ligament pain: symptoms
Pain is usually felt along the inner midfoot, near the navicular bone, and worsens with weight-bearing — walking, running, or prolonged standing. In severe cases, there may be swelling and bruising.
As the condition worsens, maintaining normal foot posture becomes harder. With a complete rupture, the arch can begin to collapse, leading to a flatfoot deformity.
How is a spring ligament injury diagnosed?
A careful clinical assessment is needed. The examination includes palpating the inner foot to locate tenderness and assessing the foot’s alignment and stability. A single-leg heel raise tests the posterior tibial tendon — if that tendon is working normally on heel raise, but there’s still inner-arch pain, an isolated spring ligament tear should be suspected.
Imaging confirms the diagnosis:
- X-rays may rule out bone injury or degenerative changes, but they don’t directly show the ligament.
- Ultrasound can assess the spring ligament and any associated tendon problems.
- MRI is the best test for diagnosing a spring ligament tear and detecting related problems such as the posterior tibial tendon and midfoot joint disease.
Other causes of inner ankle and foot pain need to be excluded, including posterior tibial tendonitis, a navicular or talus stress fracture, tarsal coalition, subtalar or ankle joint arthritis, a deltoid ligament sprain, and an accessory navicular (os naviculare).
Treatment of a spring ligament sprain or tear
Treatment depends on severity.
Conservative management works for mild to moderate sprains. Rest and activity modification are essential, avoiding activities that overstrain the foot. Immobilisation in a boot or a supportive orthotic can reduce stress on the ligament. Physiotherapy is key — strengthening the posterior tibial tendon and the intrinsic foot muscles stabilises the arch, and custom orthotics with arch support reduce strain during movement. NSAIDs help manage pain and inflammation.
For more stubborn cases, PRP injections have been explored to promote healing in partial tears.
When is surgery needed?
Surgery is reserved for cases where conservative treatment fails or where there’s a complete tear. Options include direct ligament repair or reconstruction with a tendon graft. If a flatfoot has developed, additional procedures such as osteotomies may be needed to restore alignment.
Returning to activity
Rehab must be gradual. Weight-bearing is initially limited to focus on strength and stability, then activities such as running and jumping are slowly reintroduced with appropriate arch support. The timeline depends on severity: mild sprains often settle within a few weeks, while severe injuries need several months of rehab, and surgical cases can take six months or more to return to impact.
Frequently asked questions about a spring ligament sprain
How long does a spring ligament sprain take to heal?
A mild sprain often settles within a few weeks. More severe sprains or partial tears need several months of rehab, and surgical cases (complete tears) can take six months or more before returning to impact.
Can I walk on a spring ligament sprain?
Often yes, but with care — walking may be painful, and a supportive boot or orthotic helps offload the ligament early on. Activities that strain the inner arch should be reduced until the pain settles, under the guidance of your doctor or physiotherapist.
Can a spring ligament tear cause flat feet?
Yes. Because the spring ligament helps support the medial arch, a complete tear can cause the arch to collapse, leading to a flatfoot deformity — which is one reason early diagnosis and treatment matter.
What’s the difference between a spring ligament sprain and posterior tibial tendonitis?
They’re closely related and often occur together — both cause inner-arch pain, and most chronic spring ligament injuries involve the posterior tibial tendon. The single-leg heel raise helps distinguish them, and MRI clarifies which structures are involved.
Do I need surgery for a spring ligament tear?
Usually not. Most sprains and partial tears improve with rest, orthotics, and physiotherapy. Surgery is reserved for complete tears, failed conservative treatment, or an associated flatfoot deformity.
Final word from Sport Doctor London about a spring ligament sprain
Spring ligament injuries are less common than other foot injuries, but they can significantly affect an athlete’s ability to train and compete. Early recognition and appropriate treatment are crucial to prevent long-term problems such as flatfoot. Conservative management works for mild sprains, while severe injuries may need surgery. If you have persistent inner-foot pain or instability, see a sports medicine doctor for an accurate diagnosis and treatment plan.
To book a foot and ankle assessment with Dr Masci in London, contact the team here or call +44 (0) 203 488 0350.
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