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Plantar cuboideonavicular ligament

The plantar cuboideonavicular ligament is a small but significant structure in the plantar aspect of the midfoot, connecting the cuboid and navicular bones. It reinforces the plantar portion of the cuboideonavicular joint, contributing to the stability of the lateral and medial longitudinal arches of the foot.

Although less frequently discussed than other plantar ligaments, it plays an important role in maintaining midfoot alignment and resisting plantar displacement of the cuboid relative to the navicular. Damage or degeneration of this ligament may contribute to midfoot instability, chronic pain, or deformities such as flatfoot or lateral column collapse.

Synonyms

  • Inferior cuboideonavicular ligament

  • Plantar ligament of the cuboideonavicular joint

Origin, Course, and Insertion

  • Origin: Arises from the plantar surface of the cuboid bone, near its medial aspect.

  • Course: Fibers pass medially and slightly anteriorly, forming a strong, short band along the plantar aspect of the cuboideonavicular articulation.

  • Insertion: Attaches to the plantar surface of the navicular bone, blending anteriorly with fibers of the long plantar ligament and spring ligament (plantar calcaneonavicular ligament).

Relations

  • Superiorly: Cuboideonavicular joint capsule and joint cavity

  • Inferiorly: Plantar aponeurosis and soft tissue of the sole

  • Medially: Spring ligament complex (plantar calcaneonavicular ligament)

  • Laterally: Long plantar ligament and plantar cuboid surface

  • Anteriorly: Tendons of the flexor hallucis longus and flexor digitorum longus crossing obliquely

  • Posteriorly: Short plantar ligament and peroneus longus tendon groove on the cuboid

Arterial Supply

  • Lateral plantar artery (branch of posterior tibial artery)

  • Dorsalis pedis artery via its arcuate or lateral tarsal branches

  • Small anastomoses from medial plantar branches

Function

  • Stabilization: Supports the plantar aspect of the cuboideonavicular joint

  • Arch support: Contributes to integrity of the medial and lateral longitudinal arches

  • Load distribution: Resists downward or plantar displacement of midfoot bones during weight bearing

  • Joint reinforcement: Works in synergy with the spring and long plantar ligaments to maintain the midfoot structure

Clinical Significance

  • Injury: May occur from twisting or overuse, often as part of midfoot (Chopart joint) trauma

  • Degeneration: Chronic strain can contribute to midfoot instability and pain

  • Association: Often involved in plantar midfoot sprains and complex ligamentous injuries of the tarsal region

  • Symptoms: Localized plantar pain between cuboid and navicular, worsened by weight bearing or arch stress

  • Imaging importance: MRI is preferred for direct visualization; CT helps assess associated bone injury or alignment changes

MRI Appearance

  • T1-weighted images:

    • Ligament appears as a thin, low-signal (dark) band connecting cuboid and navicular on the plantar side.

    • Surrounding fat and muscle show intermediate-to-bright signal.

    • Disruption or thickening appears as irregular intermediate signal in acute or chronic injury.

  • T2-weighted images:

    • Normal ligament: dark to low-intermediate signal, darker than muscle.

    • Tears or strain: bright linear or focal hyperintense signal replacing the dark band.

    • Adjacent bone marrow edema of cuboid or navicular may appear as bright signal in trauma.

  • STIR (Short Tau Inversion Recovery):

    • Normal: low signal band along plantar midfoot.

    • Pathology: bright hyperintensity within or surrounding the ligament indicating edema, inflammation, or partial rupture.

  • Proton Density Fat-Saturated (PD FS):

    • Normal ligament: thin, sharply marginated dark band.

    • Partial tears: focal bright signal within fibers, sometimes with periligamentous fluid.

    • Chronic degeneration: irregular, thickened low-to-intermediate signal replacing normal architecture.

  • T1 Fat-Sat Post-Contrast:

    • Normal: minimal enhancement.

    • Inflamed or healing ligament: linear or patchy enhancement along fibers.

    • Chronic fibrosis: minimal enhancement with thickened band.

CT Appearance

Non-Contrast CT:

  • Ligament itself not directly visualized but appears as a fine low-density soft tissue band between cuboid and navicular.

  • Useful for evaluating joint alignment, subluxation, or associated tarsal fractures.

  • Chronic injury may show osteophyte formation or sclerosis at the cuboideonavicular margins.

Post-Contrast CT (standard):

  • May show mild enhancement of inflamed soft tissues in acute injury.

  • Not routinely used for isolated ligament evaluation.

MRI images

Plantar cuboideonavicular ligament axial cross sectional anatomy 3T MRI AI enhanced radiology image-img-00000-00000

MRI images

Plantar cuboideonavicular ligament axial cross sectional anatomy 3T MRI AI enhanced radiology image-img-00000-00000