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Role of Spring and Deltoid Ligament Reconstruction for Adult Acquired Flatfoot Deformity

Patel, Milap S. DO*,†; Barbosa, Mauricio P. MD; Kadakia, Anish R. MD*,†

Techniques in Foot & Ankle Surgery: September 2017 - Volume 16 - Issue 3 - p 124–135
doi: 10.1097/BTF.0000000000000166
Special Focus: Soft Tissue Reconstruction in the Foot and Ankle

Failure of the spring ligament is a known pathologic process in the setting of adult acquired flatfoot deformity (AAFD). Many surgical techniques have been described to correct the deformity associated with adult acquired flatfoot deformity; however, there are limited techniques available to reconstruct the spring ligament. The goal of spring ligament reconstruction is to restore the primary ligamentous stabilizer of the talonavicular joint and restore the stability of the hindfoot without creating secondary deformity and hindfoot rigidity. Stage IV flatfoot deformity may result in ankle valgus that places asymmetric stress on the tibiotalar joint that is ideally treated with a secondary reconstruction to avoid ankle arthrodesis or arthroplasty. Despite involving the tibiospring and deep deltoid in the Deltoid reconstruction, restoration of the normal tibiotalar relationship has proven difficult, particularly in the setting of hindfoot arthrodesis, where increased stress on the medial collateral ligament complex worsens the deformity. Spring ligament reconstruction is an evolving technique and we describe a reproducible technique with promising early clinical results.

Level of Evidence: Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

*Feinberg School of Medicine, Northwestern University

Department of Orthopedic Surgery, Northwestern Memorial Hospital, Chicago, IL

Albert Einstein Hospital, Clinical Orthobone, Sao Paulo, Brasil

A.R.K. or an immediate family member has received royalties from Acumed and Biomedical Enterprises; is a member of a speakers’ bureau or has made paid presentations on behalf of Acumed and Depuy Synthes; serves as a paid consultant to or is an employee of Acumed, Biomedical Enterprises, Celling Biosciences, and Arthrex; has received research or institutional support from Acumed amd Depuy Synthes; and serves as a board member, owner, officer or committee member of the American Academy of Orthopaedic Surgeons and the American Orthopaedic Foot and Ankle Society. The remaining authors declare no conflict of interest.

Address correspondence and reprint requests to Anish R. Kadakia, MD, Department of Orthopaedic Surgery, Northwestern Memorial Hospital, 676 N. St. Clair, Suite 1350, Chicago, IL 60611. E-mail:

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