Morphology and function of the neglected ligament of the foot

Abstract

The neglected ligament of the foot for the first time more precisely described by Volkmann, is a very important passive mediodorsal tensor of the longitudianl plantar arch and plays a significant role in the prevention of the development of flat feet. In 61% of cases the neglected ligament had its posterior insertion into part of the anterior border and apex of the sustentaculum tali, or in 39% into its medial border. In 17% of cases the neglected ligament was separated from the plantar cacaneo-navicular ligament by fissure-like space filled with adipose tissue, but in others it transited into this ligament without a clear border. Neglected ligament was tightly ingrow into the medial part of the lower surface of the talus head in 10% of cases. It was as a whole diagonally oriented and its fibers radially diverged from the sustentaculum tail, obliquely crossing the static axis of the foot. It had a fan-like appearance, with a wide anterior and narrow posterior insertion, a long outer and considerably shorter inner edge. Microscopic examination revealed that it was formed by collagen fibers, with exception of its fibrocartilaginous structure in the part closely associated with the upper border of navicular fibrocartilage. The articular surface of the neglected ligament was covered by typical synovial membrane rich in blood vessels.