Ligament Insufficiency with Flatfoot: Spring Ligament and Deltoid Ligament

The objective of this article was to review the deltoid ligament and spring ligament specifically as they pertain to ligament insufficiency and adult-acquired flatfoot deformity. Discussion includes the normal and abnormal biomechanical forces that extend through these ligaments in normal and flatfoot deformity. Current literature related to spring ligament repair as part of the flatfoot deformity reconstruction is also reviewed.

Current Concepts in Treatment of Ligament Incompetence in the Acquired Flatfoot

Flatfoot deformity consists of a loss of medial arch, hindfoot valgus, and forefoot abduction. Historically considered a posterior tendon insufficiency, multiple ligament damage and subsequent incompetence explain the different clinical presentations with varying degrees of deformity. When surgery is deemed necessary, depending on the apex of the deformity, skeletal and soft tissue procedures are considered to keep motion and restore function. Osteotomies are considered at every level where an apex of deformity is found. The recently designated tibiocalcaneonavicular ligament comprises the older superficial and deep deltoid and spring ligaments; its repair or reconstruction should be considered in most flatfoot cases.