Spring ligament Sprain: How to Manage It

Causes of Spring Ligament Injury

A spring ligament injury can occur due to both acute trauma and overuse.

Acute injuries, such as a sudden twisting motion or an awkward landing, can stretch or tear the ligament. Athletes involved in sports that require jumping, pivoting, or running on uneven surfaces are at a higher risk of sustaining these injuries.

Overuse injuries can also lead to a slow breakdown of the ligament, especially in athletes who engage in high-impact activities such as long-distance running or gymnastics. People with posterior tibial tendonitis or excessive pronation are particularly susceptible, as these conditions place increased stress on the inside of the ankle. Most chronic injuries to the spring ligament are associated with posterior tibial tendon disease. 

Spring Ligament Pain Symptoms

Patients often report pain along the inner side of the midfoot, near the navicular bone. This pain may worsen with weight-bearing activities such as walking, running, or prolonged standing. In severe cases, swelling and bruising may be present. 

Patients may experience difficulty maintaining normal foot posture as the condition worsens. In cases of complete ligament rupture, the arch of the foot may begin to collapse, leading to flatfoot deformity. 

Diagnosis of Spring Ligament Injuries

A thorough clinical assessment is necessary to diagnose a spring ligament sprain or tear. The examination typically involves palpation of the inner foot to identify areas of tenderness, as well as an evaluation of the foot’s alignment and stability. A single-leg heel raise test is often used to assess the function of the posterior tibial tendon. An isolated spring ligament tear should be suspected if the posterior tibial tendon is functioning as seen on a heel raise. 

Imaging studies play a crucial role in confirming the diagnosis.

• X-rays may rule out bone injuries or degenerative changes, but do not directly visualise other structures.

• Ultrasound can help assess the spring ligament structure and associated tendon abnormalities.

• MRI remains the best imaging modality for diagnosing a spring ligament tear and detecting other abnormalities, such as posterior tibial tendon and mid-foot joint disease. 

Other causes of inside ankle pain in active individuals need exclusion and include the following:

• Posterior tibial tendonitis 
• Stress Fractures of the Navicular or Talus 
• Tarsal Coalition 
• Subtalar or Ankle joint arthritis 
• Deltoid Ligament Sprain 
• Os Naviculare 

Treatment of Spring Ligament Sprains and Tears

The treatment of spring ligament pain depends on the severity of the condition.

Conservative management is effective for mild to moderate sprains. Rest and activity modification are essential to healing, and patients may be advised to avoid activities that place excessive strain on the foot. Immobilisation, such as a boot or supportive orthotic, may also reduce stress on the ligament. 

Physical therapy plays a key role in rehabilitation. Strengthening exercises for the posterior tibial tendon and intrinsic foot muscles stabilise the arch. Custom orthotics with arch support can help reduce strain on the ligament during movement. Non-steroidal anti-inflammatory drugs (NSAIDs) may be used to manage pain and inflammation.

For more severe cases, advanced treatments may be necessary. Platelet-rich plasma (PRP) injections have been explored as a potential option for promoting healing in partial ligament tears. 

Surgical Management

Surgery is reserved for cases in which conservative treatment fails or when a complete ligament tear occurs. Surgical options may include direct ligament repair or reconstruction using tendon grafts. If a patient has developed a flatfoot, additional procedures such as osteotomies may be required to restore proper foot alignment. 

Returning to Activity

Rehabilitation following a spring ligament injury must be gradual. Initially, weight-bearing activities should be limited, focusing on regaining strength and stability. As symptoms improve, patients can slowly reintroduce activities such as running or jumping while continuing to use appropriate arch support. 

The recovery timeline varies depending on the severity of the injury. Mild sprains typically resolve within a few weeks, while more severe injuries require several months of rehabilitation. Surgical cases may take longer, with a return to impact often taking six months or more.

Final Word from Sportdoctorlondon about a Spring Ligament Sprain 

Spring ligament injuries, while less common than other foot injuries, can significantly impact an athlete’s ability to participate in sports. Early recognition and appropriate treatment are crucial to prevent long-term complications such as a flatfoot. Conservative management is effective in mild sprains, but severe injuries often require surgical intervention. If you experience persistent medial foot pain or instability, consult a sports medicine professional for the correct diagnosis and treatment plan.