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A ligament connects a bone to a bone, and the Bifurcate ligament attaches the anterior process of the calcaneus bone to the cuboid and navicular bones in a Y-shape. As the foot moves into inversion, it places increased stress on the Bifurcate Ligament; if this is greater than the ligament can tolerate, it can result in a tear or Avulsion fracture.
Bifurcate Ligament Sprain symptoms include pain on the inner aspect of the foot close to the heel bone, and there may be some subtle swelling on the hindfoot.
Weight-bearing in standing or walking can be painful, as can plantarflexion or supination of the foot.
The most common cause of a Bifurcate Ligament injury is a lateral ankle sprain, which places high force and strain on the ligament.
The likelihood of a Bifurcate Ligament Sprain increases if the ankle sprain occurs while the foot is in plantarflexion which is common for people wearing heels.
A clinical assessment can reveal slightly distal pain to the specific location of a lateral ankle sprain, while an x-ray is the most common scan for an ankle sprain. An oblique x-ray can identify an Avulsion fracture of the Bifurcate Ligament.
An MRI can establish greater clarity over a Bifurcate Ligament Sprain, while a CT Scan can provide more information on an Avulsion fracture.
Treatment for a Bifurcate Ligament Injury is ordinarily conservative. It commences with 4-6 weeks in a walker boot, where a patient weans out under a physical therapist’s guidance as pain allows.
Strengthening and balance exercises can address muscular atrophy from wearing the boot, and an ankle brace may be recommended for extra support in the early stages of rehabilitation.
As the foot and ankle become stronger, rehabilitation should become more dynamic with plyometric and change of direction exercises.
Unstable or comminuted fractures may need surgery, which should be discussed with an Orthopaedic consultant.
This is not medical advice and we recommend a consultation with a medical professional such as James McCormack before trying any of these exercises. James offers Online Physiotherapy Appointments for £45.
Related Article: Sprained Ankle: Symptoms & Treatment