Deltoid ligament injuries: diagnosis and management.
ABSTRACT The medial ligaments of the ankle are injured more often than generally believed. Complete deltoid ligament tears are occasionally seen in association with lateral malleolar fractures or bimalleolar fractures. Chronic deltoid ligament insufficiency can be seen in several conditions, including posterior tibial tendon disorder, trauma- and sports-related deltoid disruptions, and valgus talar tilting in patients who have a history of triple arthrodesis or total ankle arthroplasty. This article focuses on the anatomy and function of the medial ligaments of the ankle and establishes a rationale for the diagnosis and treatment of incompetent deltoid ligament.
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ABSTRACT: On 34 osteoligamentous ankle preparations the function of the various components of the deltoid ligament has been elucidated by tracing mobility patterns after successive transection of the components in varying sequence. The anterior and posterior talofibular ligaments were included in the study to investigate the interaction between these structures and the deltoid ligament. The tibiocalcaneal and the intermediate tibiotalar ligaments control abduction of the talus. The anterior tibiotalar and talofibular ligaments control plantar flexion, while dorsiflexion is inhibited by the posterior tibiotalar and talofibular ligaments, and partly by the anterior talofibular ligament as well. In combination, the anterior and intermediate tibiotalar ligaments control external rotation, while the intermediate and posterior tibiotalar ligaments control both external and, together with the anterior talofibular ligament, internal rotation of the talus. Isolated, neither the anterior nor the posterior tibiotalar ligament appears to play any major role in ankle stability.Acta Orthopaedica Scandinavica 03/1983; 54(1):36-44.
Article: Medial ankle instability.[show abstract] [hide abstract]
ABSTRACT: Medial instability is suspected on the basis of a patient's ankle feeling like it is "giving way," especially medially, when walking on uneven ground, downhill, or down stairs, pain at the anteromedial aspect of the ankle, and sometimes pain in the lateral ankle, especially during dorsiflexion of the foot. A history of a chronically unstable feeling that is manifested by recurrent injuries with pain, tenderness, and sometimes bruising over the medial and lateral ligaments, is considered to indicate combined medial and lateral instability that is believed to result in rotational instability of the talus in the ankle mortise. Pain on the medial gutter of the ankle and a valgus and pronation deformity of the foot are hallmarks of the disorder. The deformity typically can be corrected by the activation of the posterior tibial muscle. In contrast to stress radiographs, arthroscopy is a helpful diagnostic tool in verifying medial instability; it proved that the lateral ankle ligaments also can be involved. The treatment for symptomatic medial instability of the ankle might include reconstruction of all involved ligaments at the medial, and, if necessary, the lateral ankle. In the case of progressed foot deformity or bilateral long-standing valgus and pronation deformity of the foot, an additional calcaneal lengthening osteotomy might be considered. A classification of the instability into three types has been helpful for determining surgical treatment and the after treatment. This treatment concept provides high patient satisfaction and reliable clinical results.Foot and Ankle Clinics of North America 01/2004; 8(4):723-38. · 0.90 Impact Factor
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ABSTRACT: The surgical treatment of adult acquired flatfoot deformity secondary to posterior tibial tendon dysfunction is controversial, especially for the stage 2 posterior tibial tendon dysfunction in which the deformity is still flexible. It has been widely recognized that isolated soft tissue procedures do not provide stable correction of the deformity, which often progresses and becomes painful. For this reason, bony osteotomies have been combined with tendon transfers and ligament reconstruction in an attempt to give long-lasting correction of both pain and deformity. Lateral calcaneal lengthening osteotomy, as originally described by Evans in child flatfoot, was found to restore the medial longitudinal arch and to correct forefoot abduction, thus allowing to minimize the strain and to reach a successful function of the medial ligament reconstruction and tendon transfers. The closer the osteotomy of the calcaneus is to the calcaneocuboid joint, the more likely the anterior calcaneus becomes unstable, which, in turn, may provoke incongruency and pressure increase at the calcaneocuboid joint. This article describes the author's preferred more posteriorly located calcaneal osteotomy along the anterior border of the posterior subtalar facet.Techniques in Foot & Ankle Surgery 05/2003; 2(2):84-90.