The bifurcate ligament is a Y-shaped ligament on the dorsum of the midfoot, arising from the anterior process of the calcaneus and dividing into a medial (calcaneonavicular) limb and a lateral (calcaneocuboid) limb. It reinforces both halves of the Chopart (midtarsal) joint from their shared calcaneal origin. Its pull can avulse the tip of the anterior process in inversion and plantarflexion injuries, an injury often mistaken for an ordinary ankle sprain.
| Origin | Dorsal surface of the anterior process of the calcaneus |
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| Insertion | Two limbs: calcaneonavicular to the dorsolateral navicular, and calcaneocuboid to the dorsomedial cuboid |
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Binds the calcaneus to the navicular and cuboid, reinforcing the dorsolateral midtarsal joint.
Bifurcate ligament avulsion from the anterior process of the calcaneus produces a small fracture fragment that is easily missed on standard ankle views; an oblique foot view or CT shows it. Tenderness lies over the anterior process, distal and anterior to the ATFL, rather than over the fibular ligaments. Undisplaced fragments are treated with immobilisation for about 4-6 weeks, while large displaced fragments may need fixation and symptomatic non-unions excision. A missed injury can leave chronic lateral midfoot pain.
Avulsion of the bifurcate ligament origin in an inversion and plantarflexion injury, producing dorsolateral midfoot pain that outlasts a typical sprain, confirmed on oblique radiograph or CT.
Ligament tear without fracture causing dorsolateral midfoot pain and swelling at the Chopart joint, managed with protected weight-bearing and rehabilitation.
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