The injury of the Calcaneocuboid ligaments

The selective rupture of the calcaneocuboid ligament is extremely rare and frequently misdiagnosed. This study tries to clarify the mechanism, classif ication and treatment of this entity. The necessity of radiographs with var us stress and in certain cases of computer tomography (CT) and magnetic res onance imaging (MRI), beside the routine antero-posterior and lateral views , is emphasized. Thirteen cases out of five-hundred-twenty-one sprain injur ies of the ankle are described, classified and the therapy discussed: If on varus stress radiographs, there is a calcaneocuboid angle <10 degrees with out a bony flake (type I)strapping for six weeks is indicated. A calcaneocu boid angle >10 degrees with or without a small bony flake of the ligament i nsertion (type 2) should primarily be treated with a shoe cast for 6 weeks; if there are persistent symptoms a secondary peroneus brevis tendon graft is recommended. A calcaneocuboid angle >10 degrees with a big flake (type 3 ) should be treated by open reduction and refixation of the ligament. Compl ex injuries (type 4) are characterised by cuboid compression fracture and l igament rupture.