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Duke Orthopaedics
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Wheeless' Textbook of Orthopaedics

Deltoid Ligament 



- See: Deltoid Ligament Injuries due to Ankle Fractures

- Anatomy and Function:
    - medial side of ankle is stabilized by deltoid ligament, which always has: tibionavicular, tibiospring, and deep posterior tibiotalar ligaments
    - superficial deltoid:
           - originates from anterior & inferior aspects of medial malleolus fanning out & sending 3 bands to navicular and along plantar
                     calcaneonavicular (spring) ligament, to sustenaculum tali of calcaneus, & to medial tubercle;
           - superficial deltoid lig primarily resists eversion of hindfoot;
           - tibionavicular portion suspends spring lig & prevents inward displacement of head of talus, while tibiocalcaneal portion
                     prevents valgus displacement.
           - superficial deltoid is also partially covered by tendon sheaths & crural fascia;
    - deep deltoid ligament:
           - originates on posterior border of anterior colliculus, intercollicular groove, & posterior colliculus;
           - it is oriented transversely & inserts into entire nonarticular surface of medial talus;
           - deep deltoid extends function of medial malleolus & prevents lateral displacement of talus & prevents external
                   rotation of the talus;
                   - latter effect is pronounced in plantar flexion, when deep deltoid tends to pull talus into internal rotation;
           - originates from inferior & posterior aspects of medial malleolus and inserts on medial and posteromedial
                   aspects of the talus;

- Physical Exam:
    - eversion test;
          - in neutral evaluates superficial deltoid ligament complex;
    - external rotation stress test evaluates syndesmotic ligaments and additionally - the deep deltoid ligament;

- Fractures w/ Deloid Injury:
    - see: deltoid ligament injuries due to ankle fractures
    - in absence of a medial malleolar fracture deltoid ligament may be stretched or torn in all oblique frx of fibula;
    - this ligament prevents posterior tibial tendon from slipping into Ankle Joint;
    - ligament ultimately heals in a lengthen position;
    - these patients are often diagnosed as having chronic deltoid sprains;
    - main problem, however, is lateral talar shift resulting from malunited frx of lateral malleolus or a syndesmotic ligament  injury, which
              widens mortise & produces chronic ankle instability;

- Radiographic Diagnosis of Injury:
    - deloid is usually avulsed from tibial attachment, frequently w/ small flake of bone visible on x-rays;
    - disruption of deltoid ligament can be dxed w/ relative confidence when medial clear space between talus & med malleolus is increased;
    - lateral shift of talus, w/ incr medial joint space ( > 3 mm), but this may be apparent only on stress view or in postcasting films, after swelling has subsided;
    - presence of medial tenderness & > 5 mm of space is seen then there is substantial injury of deltoid ligament;

- Treatment of Deltoid Tear:
    - such injuries should be rxed as bimalleolar frx, w/ ORIF of lateral malleolus;
    - routine exploration of medial side of ankle is not necessary unless there is evidence that portion of deltoid lig has entered joint & is blocking reduction of talus



Fractures of the distal part of the fibula with associated disruption of the deltoid ligament. Treatment without repair of the deltoid ligament.

The deltoid ligament. An evaluation of need for surgical repair.

The medial collateral ligaments of the human ankle joint: anatomical variations.

The effects of sectioning the spring ligament on rearfoot stability and posterior tibial tendon efficiency.

Anatomical reconstruction of the spring ligament using peroneus longus tendon graft

The Ligament Anatomy of the Deltoid Complex of the Ankle: A Qualitative and Quantitative Anatomical Study





Original Text by Clifford R. Wheeless, III, MD.

Last updated by Clifford R. Wheeless, III, MD on Monday, July 28, 2014 8:00 pm