Lesion of the ligamentum bifurcatum in ankle sprain

In a consecutive study of 106 patients with a history of ankle sprain, 40.5% showed clinical signs of damage to the ligamentum bifurcatum of the midfoot. A significantly larger percentage of these patients complained of maximum tenderness localized to the instep compared with the patients without signs of damage to the ligamentum bifurcatum (P less than 0.001). Radiologic examination revealed 20 lesions related to damage to the ligamentum bifurcatum: laxity in the transverse tarsal joint, 12; avulsion from the anterior process of the calcaneus, 5; avulsion from the cuboid, 2; avulsion from the navicular, 1. The clinical importance of these findings is debatable. Previous investigations have revealed hypermobile ankles in patients with laxity in the transverse tarsal joint, as well as long convalescence time and risk of nonunion in patients with fractures of the anterior process of the calcaneus. It is therefore recommended that patients with a history of ankle sprain be evaluated concerning damage to the ligamentum bifurcatum of the midfoot.