The bifurcate ligament is a Y-shaped structure arising from the anterior process of the calcaneus, splitting into a calcaneonavicular component (joining the spring ligament complex) and a calcaneocuboid component (joining the dorsal calcaneocuboid ligament).
Stabilises both limbs of the Chopart (midtarsal) joint from their common calcaneal origin, provides lateral midfoot stability, and is the ligament involved in anterior process calcaneal fractures.
Bifurcate ligament avulsion from the calcaneal anterior process produces the anterior process fracture — the "fleck sign" on lateral ankle X-ray. This injury is commonly missed as a lateral ankle sprain. CT scan identifies the avulsion fragment. Displaced fragments require ORIF; undisplaced fractures are managed in a cast.
Bifurcate ligament avulsion from the calcaneal anterior process in inversion injury producing lateral hindfoot pain persistent beyond typical ankle sprain, confirmed by CT and managed by ORIF if displaced.
Bifurcate ligament avulsion commonly missed as a routine lateral ankle sprain, leading to chronic lateral midfoot pain if untreated, requiring delayed ORIF or fibrous union acceptance.
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