Deltoid Ligament Repair in Flatfoot Deformity

Oburu, Ezekiel; Myerson, Mark S.

doi:10.1016/j.fcl.2017.04.001

Cited by 14 publications

(4 citation statements)

References 20 publications

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“…While supramalleolar realignment has been regarded as the principal method of joint preservation surgery in asymmetric varus ankle arthritis, the treatment of primary valgus ankle arthritis described in the literature has focused mainly on the correction of inframalleolar causes, specifically deltoid ligament insufficiency. 2,6,22 Furthermore, the utility of supramalleolar correction has only been described in the correction of posttraumatic valgus ankles. 15 The rationale behind this approach lies in the long-held belief that insufficiency of the deltoid ligament from hindfoot valgus or posterior tibial tendon dysfunction may be a leading cause of primary valgus ankle arthritis as the deltoid ligament is the main structure resisting valgus talar tilt.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 Consequently, joint preservation methods have primarily focused on inframalleolar realignment procedures, such as deltoid ligament reconstruction with concomitant hindfoot alignment correction. 6,9,22 In recent radiographic studies, a distinct relationship was observed between valgus ankle arthritis and specific lower limb alignment or subtalar joint orientation. 4,5,10,14 Anecdotally, we have observed a subset of valgus arthritic ankles with varus malalignment of the mechanical axis and/ or tibial plafond without evidence of deltoid ligament insufficiency.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of Joint Preservation Surgery in Valgus Ankle Arthritis Without Deltoid Ligament Insufficiency

Kim¹,

Lee²

2021

Foot Ankle Int.

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Background: To date, information about the role of proximal alignment correction in treating nontraumatic valgus ankle arthritis is limited. This study aimed to report outcomes of realignment surgery, including supramalleolar correction in valgus arthritic ankles without evidence of deltoid ligament insufficiency. Methods: Thirteen patients (13 ankles) who underwent joint preservation surgery for valgus ankle arthritis without evidence of deltoid ligament insufficiency were reviewed. Medial opening wedge supramalleolar osteotomy ( n = 11) and varization supramalleolar dome osteotomy ( n = 2) were performed to realign the hip-knee-ankle-hindfoot axis. Concomitant hindfoot correction was accompanied with either medial displacement calcaneal osteotomy ( n = 8) or subtalar arthrodesis ( n = 5). Pain, functional outcome (Foot Function Index [FFI]), radiographic arthritis grade (grades 0-4), 9 plain radiographic parameters, and 2 weightbearing computed tomography parameters were evaluated pre- and postoperatively. All patients completed a minimum 2-year follow-up. Results: Preoperatively, 10 ankles (77%) demonstrated a varus tibial plafond, and 3 ankles (23%) demonstrated a valgus or neutral tibial plafond. Postoperatively, radiographic arthritis grade improved in all except 1 patient, and the mean talar tilt angle improved from 5.5 to 1.7 degrees. The mean pain score (visual analog scale) decreased significantly from 7.3 to 2.5 ( P < .05), and the mean FFI improved significantly from 57.7 to 18.6 ( P < .001). None of the patients underwent conversion to joint-sacrificing procedures at the latest follow-up. Conclusion: This study demonstrated a possible relationship between lower limb malalignment and valgus ankle arthritis. Realignment surgery, including supramalleolar osteotomies, which straightens the mechanical axis and decreases the slope of the tibial plafond, may be a reasonable approach in joint preservation of valgus ankle arthritis without deltoid ligament insufficiency. Level of Evidence: Level IV, case series.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Outcomes of Joint Preservation Surgery in Valgus Ankle Arthritis Without Deltoid Ligament Insufficiency

Kim¹,

Lee²

2021

Foot Ankle Int.

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“…Symptoms at this stage often shift from the foot to the ankle joint. Deltoid ligament reconstruction, in addition to the flatfoot realignment procedures already described, is used while the ankle joint is still flexible (67,88). If the tibiotalar joint is fixed in valgus or has substantial arthritis, tibiotalar fusion may be necessary.…”

Section: Stage IVmentioning

confidence: 99%

Adult Acquired Flatfoot Deformity: Anatomy, Biomechanics, Staging, and Imaging Findings

Flores¹,

Gómez²,

Hernando³

et al. 2019

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■ Describe the anatomy and function of each of the principal stabilizers of the medial arch and how their dysfunction leads to AAFD. ■ Assess foot malalignment with standard radiographic metrics and recognize imaging findings that indicate damage to the supporting structures of the foot. ■ Explain the principles of clinical staging of AAFD and the most commonly used treatment options for each stage.

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“…The ankle valgus tilt can be identified on a WEIGHTBEARING anteroposterior conventional radiographs of the ankle. 25,31 The IE patients correspond to the Bluman et al IVA, supple tibiotalar valgus, category. The treatment of PCFD IE patients is widely recognized as challenging.…”

Section: Deltoid Ligamentmentioning

confidence: 99%

Indications for Deltoid and Spring Ligament Reconstruction in Progressive Collapsing Foot Deformity

et al. 2020

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Recommendation: There is evidence supporting medial soft tissue reconstruction, such as spring and deltoid ligament reconstructions, in the treatment of severe progressive collapsing foot deformity (PCFD). We recommend spring ligament reconstruction to be considered in addition to lateral column lengthening or subtalar fusion at the initial operation when those procedures have given at least 50% correction but inadequate correction of the severe flexible subluxation of the talonavicular and subtalar joints. We also recommend combined flatfoot reconstruction and deltoid reconstruction be considered as a joint sparing alternative in the presence of PCFD with valgus deformity of the ankle joint if there is 50% or more of the lateral joint space remaining. Level of Evidence: Level V, expert opinion.

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Deltoid Ligament Repair in Flatfoot Deformity

Cited by 14 publications

References 20 publications

Outcomes of Joint Preservation Surgery in Valgus Ankle Arthritis Without Deltoid Ligament Insufficiency

Outcomes of Joint Preservation Surgery in Valgus Ankle Arthritis Without Deltoid Ligament Insufficiency

Adult Acquired Flatfoot Deformity: Anatomy, Biomechanics, Staging, and Imaging Findings

Indications for Deltoid and Spring Ligament Reconstruction in Progressive Collapsing Foot Deformity

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