Spring ligament

Abstract: In spite of the common occurrence of pes planus and multiple operations that have been reported to relieve the associated symptoms, there is little published on the relative contribution of various structures to stabilization of the arch of the foot. Twelve fresh-frozen human cadaveric feet were loaded along the tibial axis with compressive loads of 230, 460, and 690 newtons with the specimens intact and after sequential sectioning of plantar fascia, plantar ligaments, and spring ligament. Structures were sectioned in six different sequences and changes in vertical and horizontal dimensions of the medial arch were measured. The highest relative contribution to arch stability was provided by the plantar fascia, followed by plantar ligaments and spring ligament. Plantar fascia was a major factor in maintenance of the medial longitudinal arch. Its division in the cadaveric feet decreased arch stiffness by 25%.

Abstract: Background: The pathology manifested in posterior tibial tendon insufficiency (PTTI) is not limited to the posterior tibial tendon. The association of ligament failure with deformity has been discussed in numerous publications, but extensive documentation of the structures involved has not been performed. The purpose of this observational study was to identify the pattern of ligament involvement using standarized, high-resolution magnetic resonance imaging (MRI) in a series of 31 consecutive patients diagnosed with PTTI compared to an age matched control group without PTTI. Method: The structures evaluated by MRI were the posterior tibial tendon, superomedial and inferomedial components of the spring ligament complex, talocalcaneal interosseous ligament, long and short plantar ligaments, plantar fascia, deltoid ligament, plantar naviculocuneiform ligament, and tarsometatarsal ligaments. Structural derangement was graded on a five-part scale (0 to IV) with level 0 being normal and level IV indicating a tea...

Abstract: Eighteen of twenty-two patients who were having a tendon transfer to treat rupture of the posterior tibial tendon had evidence of injury to the spring ligament. The injury consisted of a longitudinal tear in the ligament in seven patients, a lax ligament without a gross tear in seven, and a complete rupture of the ligament in four. The ruptured posterior tibial tendon was treated with transfer of the flexor digitorum longus in twenty of the twenty-two patients. A variety of methods were used to repair the ligament. It is essential to determine the status of the spring ligament when patients are managed for rupture of the posterior tibial tendon. Patients who have a torn or lax spring ligament in addition to the ruptured posterior tibial tendon may have more severe abnormalities of the hindfoot than those who have only a ruptured tendon.

Abstract: Background: The deltoid ligament has both superficial and deep layers and consists of up to six ligamentous bands. The prevalence of the individual bands is variable, and no consensus as to which bands are constant or variable exists. Although other studies have looked at the variance in the deltoid anatomy, none have quantified the distance to relevant osseous landmarks. Methods: The deltoid ligaments from fourteen non-paired, fresh-frozen cadaveric specimens were isolated and the ligamentous bands were identified. The lengths, footprint areas, orientations, and distances from relevant osseous landmarks were measured with a three-dimensional coordinate measurement device. Results: In all specimens, the tibionavicular, tibiospring, and deep posterior tibiotalar ligaments were identified. Three additional bands were variable in our specimen cohort: the tibiocalcaneal, superficial posterior tibiotalar, and deep anterior tibiotalar ligaments. The deep posterior tibiotalar ligament was the largest band of the deltoid ligament. The origins from the distal center of the intercollicular groove were 16.1 mm (95% confidence interval, 14.7 to 17.5 mm) for thetibionavicularligament,13.1mm (95% confidenceinterval, 11.1to15.1mm) forthetibiospring ligament,and 7.6mm (95% confidence interval, 6.7 to 8.5 mm) for the deep posterior tibiotalar ligament. Relevant to other pertinent osseous landmarks, the tibionavicular ligament inserted at 9.7 mm (95% confidence interval, 8.4 to 11.0 mm) from the tuberosity of the navicular, the tibiospring inserted at 35% (95% confidence interval, 33.4% to 36.6%) of the spring ligament’s posteroanterior distance, and the deep posterior tibiotalar ligament inserted at 17.8 mm (95% confidence interval, 16.3 to 19.3 mm) from the posteromedial talar tubercle. Conclusions: The tibionavicular, tibiospring, and deep posterior tibiotalar ligament bands were constant components of the deltoid ligament. The deep posterior tibiotalar ligament was the largest band of the deltoid ligament. Clinical Relevance: The anatomical data regarding the deltoid ligament bands in this study will help to guide anatomical placement of repairs and reconstructions for deltoid ligament injury or instability.