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Bifurcate Ligament

Bifurcate ligament:

  • This ligament connects the anterior process of the calcaneus to both the cuboid and navicular bones (indicated by green triangle in the image above)
  • Inversion stress of the foot will result in stretch of this ligament or avulsion fracture of the anterior process.
  • Often underdiagnosed by practioners outside of a foot and ankle specialty


  • Pain to the outside middle portion of the foot
  • Worse with pointing the foot downwards (plantarflexion)  or rolling the foot outwards (supination)


  • Initial medial oblique x ray should be taken with every severe ankle sprain to rule out avulsion fracture of the anterior calcaneal process, especially when symptomatic over this specific region of the foot
  • An MRI can confirm the diagnosis of bifucate ligament tear


  • Most often immobilization with cast or CAM walker for at least 4 weeks is necessary, especially if ligament is torn
  • Rarely is surgery indicated to reduce and fixate a displaced avulsion fracture of the anterior process of the calcaneus
  • Physical therapy is usually required after immobilization to restore strength and balance to the injured foot and ankle