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Deltoid Ligament

(See also: 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 also: deltoid ligament injuries due to ankle fractures)

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