This article describes the history, diagnosis, and surgical treatment of acute deltoid rupture and insufficiency. The deltoid ligament is the primary restraint to valgus stress in the ankle. Acute deltoid rupture is a relatively uncommon pathology when compared with lateral ankle ligament rupture. The mechanism is a forced ankle abduction or eversion. It is highly associated with ankle fractures and dislocations. This technique article will present a method for repair that allows for early rehabilitation and return to preinjury level of function.