Structures involved in posterior tibial tendon dysfunction

NewsBot · Nov 11, 2024

Ultrasound assessment of the spring ligament and posterior tibial tendon in healthy subjects: A descriptive study
Beatriz Martínez-Sañudo et al
Journal of Tissue ViabilityVolume 33, Issue 3, August 2024, Pages 481-486

Highlights
•There are differences between the thickness of the SMSL between men and women.
•There are differences between age and the thickness of the PTT.
•In healthy subjects the PTT was on average 0.7 times the size of the SMSL.
•A high degree of agreement was found between the measurements taken by the investigators.
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Background
The main aim of this study was to ultrasonographically analyse the thickness and the relationship between the Superomedial Bundle of the Spring Ligament and the Posterior Tibial Tendon in healthy subjects and its relationship with different epidemiological variables.
Methods
Fifty-five healthy feet with a mean of 47 years old measuring the same ultrasound model and researcher. Demographic variables (age, sex, laterality, BMI, type of sports activity performed, and type of work activity) were collected from all participants. The thickness of the PTT and the Spring Ligament was measured in both longitudinal and transverse diameters. The intraclass correlation coefficient (ICC) was also analysed to assess the agreement of the measurements between a researcher and the ultrasound specialist radiologist.
Results
The mean thickness of the Spring ligament was 5.07 mm (95 % CI 4.75–5.38), while that of the PTT in its long axis was 3.58 mm (95 % CI 3.37–3.79). Regarding the interobserver agreement analysis, the intraclass correlation coefficient for measurements between observers was 0.91 (CI95 %: 0.698–0.977) which denotes a high degree of similarity between the clinician and the radiologist.
Conclusion
This study describes the relationships between the thickness of the posterior tibial tendon and the superomedial Bundle of the Spring ligament in healthy subjects, as well as their variability according to certain epidemiological variables such as age, gender, occupation, and sport. On the other hand, the measurements taken by a researcher high agreement with those taken by a radiologist specialized in ultrasound.
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NewsBot · Nov 21, 2024

Chronic Deltoid Insufficiency in Stage IV Adult
Acquired Flatfoot Deformity: Do We Have a Good
Answer?
Jacob C. Tiell , Matias Malkamaki , Patrick O'Connor , Nicholas C. Cheney
Source

Stage IV adult acquired flatfoot deformity (AAFD) with secondary chronic deltoid ligament insufficiency is a
challenging deformity to treat, with minimal consensus in the literature concerning its surgical
management. Many surgical treatment options have been described, including joint-sparing techniques,
fusions, osteotomies, and even arthroplasties. However, questions remain as to what, if any, treatment is
optimal. This contribution reviews studies on surgical treatments for stage IV AAFD with deltoid ligament
failure and provides a critical analysis regarding the quality of outcomes reported for those different
treatment options.
PubMed and Google Scholar databases were searched between June 1, 2022, and August 15, 2022, for studies
published between 1990 and 2022 that describe the treatment of stage IV AAFD with deltoid ligament
insufficiency. Articles included in the study focused on subjects with stage IV AAFD and associated deltoid
ligament insufficiency undergoing surgical correction. Exclusion criteria included stage I, II, and III AAFD,
as well as deltoid ligament repair following acute injury/rupture.
Nine studies covering five different treatment options for patients with stage IV AAFD and chronic deltoid
insufficiency were included, with minimal overlap in outcome measures used to assess the efficacy of the
procedure. Triple arthrodesis with deltoid ligament reconstruction resulted in a 62.5% (5/8) success rate with
a residual tibiotalar (TT) angulation of 2° (success defined as <3°). Tibiotalar arthrodesis of four patients
resulted in an average post-operative tibiotalar angulation of 4.8° with all patients showing progressive
destabilization of the hindfoot complex at 12-18 year follow-ups. Deltoid arthroscopic laminoplasty
(Brostrom) resulted in an increased American Orthopaedic Foot and Ankle Society (AOFAS) score from 49.7
pre-op to 91.9 post-op. There was no long-term follow-up of these patients. Deltoid ligament reconstruction
using autografts of the peroneus longus resulted in a post-operative valgus of 2.1° in one study and <5° in
another. Deltoid ligament reconstruction using an anterior tibial tendon autograft resulted in a gain of 126.4
+ 40.2% in stiffness compared to an intact ligament. Twinfix suture anchors resulted in a post-operative
hindfoot angle averaging 5.3°. Combined deltoid and spring ligament reconstruction resulted in a 5.1° valgus
angulation.
There is currently no standard of care or clinical consensus regarding surgical treatment for stage IV AAFD
with deltoid insufficiency. Several studies imply that mild valgus malalignment around the tibiotalar joint
can result in satisfactory outcomes. A few studies even deemed <5° of valgus tilt post-operatively successful.
However, it has been described that any imbalance in tibiotalar tilt is a significant risk factor for progressive
arthritis and future ligamentous failure. No treatment option was able to correct valgus tilt to an anatomical
standard (i.e., to normal anatomy). These varied findings, along with the lack of consensus on post-surgical
measures to assess efficacy, are worrisome and emphasize the need for better surgical options. Moreover,
there is a critical need for additional research on the long-term outcomes following stage IV AAFD and
deltoid insufficiency repair, particularly, as over five million people in the United States and 10% of the
geriatric population are affected by AAFD with a risk of progressing to stage IV.
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NewsBot · Nov 29, 2024

Comparative Analysis of Structural Differences in Progressive Collapsing Foot Deformity With and Without Hallux Valgus
Chien-Shun Wang et al
Foot Ankle Int. 2024 Nov 26

Background: Progressive collapsing foot deformity (PCFD) and hallux valgus (HV) are complex 3-dimensional deformities of the foot. This study aimed to investigate structural and alignment differences between PCFD with and without HV using weightbearing computed tomography.

Methods: Patients with PCFD aged 18 years or older who underwent weightbearing computed tomography were consecutively enrolled. Standard 2-dimensional PCFD and HV parameters were assessed semiautomatically. Foot and ankle offset, forefoot arch angle, and pronation of the medial column bones in the coronal plane, with the ground as a reference, were manually measured. Additionally, the angles from the inferior aspect of subtalar posterior facet of the talus to the ground (subtalar horizontal angle), from the inferior (posterior facet) to superior facets of the talus (infratalar-supratalar angle), and from the inferior (posterior facet) of the talus to the superior facet of the calcaneus (infratalar-supracalcaneal angle) were examined. HV deformity was defined by an HV angle of ≥15 degrees.

Results: Among 72 feet (58 patients) studied, 33 displayed HV, whereas 39 did not. In the coronal plane, the PCFD with HV group showed a higher infratalar-supratalar angle and greater pronation at the first tarsometatarsal joint, first metatarsal bone, and head. The PCFD with HV group also exhibited greater naviculocuneiform joint supination. Generalized estimating equation logistic regression analysis revealed significant associations of HV deformity with the intrinsic rotation of the first metatarsal bone (P < .001), infratalar-supratalar angle (P = .004), and rotation of the first tarsometatarsal joint (P < .001).

Conclusion: This study confirmed significant structural and alignment differences between PCFD with and without HV. Notably, the infratalar-supratalar angle, rotation of the first tarsometatarsal joint, and intrinsic rotation of the first metatarsal bone were associated with HV deformity.
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NewsBot · Dec 26, 2024

Correlation of Posterior Tibial Tendon Ultrasound with Calcaneal Inclination Angle in Indonesian Professional Athletes with Medial Ankle Pain.
Setiawati R, Hasbi A, Rahardjo P, Tinduh D, Pawana A, Lusida VGE, Guglielmi G, Mukherji S.
Int J Med Sci 2024; 21(10):1876-1883. doi:10.7150/ijms.98222. https://www.medsci.org/v21p1876.htm

Background: Adult-acquired flatfoot deformity (AAFD) is characterized by partial or complete flattening of the longitudinal medial arch, which develops after maturity. AAFD secondary to posterior tibialis tendon dysfunction (PTTD) is one of professional athletes' most common foot and ankle pathologies. Different modalities and procedures can be used to establish the diagnosis of AAFD and PTTD. However, imaging measurements such as the calcaneal inclination index and ultrasonography (US) of the posterior tibialis tendon (PTT) in professional athletes with medial ankle and focal pain along the PTT have yet to be widely studied. This study investigates the correlation of PTT ultrasound for evaluating PTTD with calcaneal inclination angle (CIA) for evaluating AAFD in professional athletes with medial ankle and focal pain along the PTT. Through this study, clinicians and radiologists may benefit from considering AAFD in athletes with PTTD.

Methods: 112 Indonesian professional athletes with medial ankle or foot pain and focal pain along the direction of the PTT underwent foot radiography using the CIA and ankle ultrasound to observe PTT abnormalities.

Results: A negative correlation between fluid thickness surrounding the PTT and the CIA (p<0.001; 95% CI - 0.945, - 0.885), as well as a negative correlation between PTT thickness and CIA (p<0.001, 95% CI - 0.926, - 0.845), with a correlation coefficient (r) of - 0.921 and - 0.892, respectively. No significant correlation was found between PTT tear and CIA (p = 0.728; 95% CI -0.223, - 0.159; r - 0.033).

Conclusion: This study showed a negative correlation between PTTD and AAFD via ultrasound and CIA in professional athletes with medial ankle and focal pain along the PTT. A better understanding of PTTD and AAFD imaging will lead to more effective management and prompt treatment.
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NewsBot · Jun 11, 2025

Congenital Absence of the Navicular Bone: A
Rare Cause of Adult-Acquired Flatfoot and
Posterior Tibial Tendon Dysfunction
Israa Alhashimi , Alaa Al-Taie , Syed Alam , Renan Ibrahem Adam
Source

The navicular bone is critical for foot biomechanics, stabilizing the midfoot through its articulation with the
talus and cuneiform bones. Variations, including accessory ossicles, hypoplasia, and complete absence, can
lead to altered foot function. We present the case of a 58-year-old female patient who experienced
persistent left foot pain. Imaging revealed the congenital absence of the navicular bone, resulting in altered
biomechanics, midfoot instability, flatfoot deformity, and secondary degenerative changes. Posterior tibial
tendon dysfunction (PTTD), a leading cause of adult-acquired flatfoot, is exacerbated by navicular
anomalies. Advanced imaging plays a critical role in diagnosis, with treatment ranging from conservative
management to surgery, depending on severity
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NewsBot · Jun 17, 2025

So What Exactly Is Progressive Collapsing Foot Deformity?
Victor Y Hong et al
J Am Acad Orthop Surg. 2025 Jun 6

Progressive collapsing foot deformity is a new nomenclature coined by a group of expert foot and ankle orthopaedic surgeons who published numerous articles on adult flatfoot deformities. The consensus statements were published in 2020 due to concern that traditional terminologies such as "posterior tibial tendon dysfunction," "adult acquired flatfoot deformity," and numerous others could be confusing to physicians/health care professionals and do not adequately encompass the deformity. The consensus group also designed a new classification system to simplify the decision-making process that could be reproducible among surgeons. This article provides an overview of the consensus statements on surgical goals and summarizes some of the newest articles on progressive collapsing foot deformity, including reliability, diagnostic accuracy, and roles of advanced imaging along with soft-tissue reconstruction. Although the new classification system has room for improvement, it offers an option to aid surgeons in approaching this complex 3-dimensional deformity and individualizing treatment for each patient's unique anatomy.
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NewsBot · Jul 1, 2025

The reliability of talonavicular uncoverage to indicate forefoot abduction in progressive collapsing foot deformity: a finite element analysis
Yulin Wei, Hua Liu & Can Xu
Journal of Orthopaedic Surgery and Research volume 20, Article number: 143 (2025)

Background
Progressive Collapsing Foot Deformity (PCFD) presents various deformities. While medializing displacement calcaneal osteotomy (MDCO) and lateral column lengthening (LCL) are commonly employed as corrective surgeries, their impact on foot structure and functionality necessitates detailed biomechanical analysis. The objective of this study is to analyze the reliability of using talonavicular uncoverage percentage (TUP) as a metric for assessing the degree of forefoot abduction.

Methods
Seven subject-specific flatfoot models were constructed based on previous study. Finite element analysis was conducted to simulate stress distribution and contact characteristics in PCFD. Models were categorized based on TUP values, and MDCO was performed to analyze stress changes in the medial longitudinal arch and contact characteristics of subtalar joint.

Results
The study revealed discrepancies in TUP measurements between plain radiographs and three-dimensional models. Comparative analysis of the seven models showed that TUP exceeding 40% showed varied stress responses. A newly introduced parameter, the distance from the center of the head of the second metatarsal to the talar body axis (DSMT), demonstrated potential as a more dependable indicator. Models with DSMT below 20 mm experienced a remarkable reduction in ligamentous stress and notable change in region of stress concentration on the subtalar joint surface after MDCO, while those above 20 mm showed no noteworthy change.

Conclusion
The study suggests that TUP may not be a reliable indicator for LCL surgery in PCFD, highlighting the need for improved assessment parameters. DSMT shows promise as a more dependable indicator, warranting further research to validate its efficacy. Enhanced indicators will facilitate better surgical planning in PCFD corrective procedures.

Clinical relevance
Accurate assessment of flatfoot deformities is crucial for developing effective treatments. DSMT , which utilizes the talar body axis as a reference, is not affected by anatomical variations in the talar head body angle, rendering it more reliable for assessment of forefoot abduc tion. Improved indicators will contribute to better surgical decision making and patient outcomes in PCFD.
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NewsBot · Jul 6, 2025

Anatomical Description of the Structures That Cause Tibialis Posterior Tendon Dysfunction
Gamze Taskin Senol et al
Cureus. 2025 Mar 7;17(3):e80196

Tibialis posterior tendon (TPT) dysfunction is defined as a clinical pathology of the foot. It occurs as a sudden and progressive loss of strength due to TPT tendinopathy as a result of causes such as vascular and acute trauma or overuse. This retrospective study aimed to identify the anatomical aspects that can cause TPT dysfunction. The association between the control group and the patient group with stage 1 TPT dysfunction was assessed. The variables evaluated for this purpose were medial malleolus type, presence and type of accessory navicular tubercle, TPT width (TPTW), TPT thickness (TPTT), retromalleolar groove width (RGW), retromalleolar groove depth (RGD), retromalleolar groove angle (RGA), anterior posterior malleolar length (APML), posterior malleolar length (PML), and total posterior malleolar length (TPML). The RGA and TPML differences between the control and patient groups were determined to be statistically significant. In our opinion, identifying the risk factors for TPT dysfunction will aid in planning the therapeutic procedure.
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NewsBot · Jul 15, 2025

Progressive Collapsing Foot Deformity: Multi-bone Modeling and Joint Level Measurements
Kassidy Knutson, Andrew C. Peterson, Rich J. Lisonbee, Takuma Miyamoto, Nicola Krähenbühl & Amy L. Lenz
Annals of Biomedical Engineering

Purpose
The objective of this study was to characterize joint level morphology and alignment differences across stages of progressive collapsing foot deformity (PCFD) within the talocrural, subtalar, talonavicular, and calcaneocuboid joints using multi-bone statistical shape modeling (SSM) and joint distance measurements from weightbearing computed tomography (WBCT) scans. This was achieved by employing multi-bone SSM in conjunction with precise joint measurement analysis, utilizing WBCT scans to investigate the intricate changes within the talocrural, subtalar, talonavicular, and calcaneocuboid joints.

Methods
A retrospective analysis was conducted on patients with PCFD who failed conservative treatment. Two groups of 20 feet each were formed for flexible PCFD and rigid PCFD, with 27 additional feet identified as asymptomatic controls. All 67 participants underwent a WBCT scan, and 3D models were created as inputs for multi-bone SSM and joint distance measures.

Results
The first principal component analysis mode contained 45.8% of the variation in the population while the second mode contained 13.3% of the variation and the third mode contained 6.4% of variation accounting for 65.6% of the overall variation in the multi-bone model. Joint space distance measurement differences were observed between all three groups for all articulations. The primary difference between flexible PCFD and rigid PCFD multi-bone SSM was a statistically significant medial shift of alignment of the talar neck, resulting in worsened peritalar subluxation.

Conclusion
PCFD is quantifiably variable across a clinical population when evaluating joint level measurements as well as morphologic and alignment variations. Talonavicular joint malalignment severity may be a clinical key in distinguishing between stages of PCFD.
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NewsBot · Jul 29, 2025

The Impact of Spring Ligament Injuries on Flatfoot Deformity: An Exploratory Study of Morphological and Radiographic Changes in 198 Patients
Roxa Ruiz et al
J Clin Med. 2025 Jul 18;14(14):5109.

Background: Spring ligament (SL) injuries are primarily associated with progressive collapsing flatfoot deformity, but can also occur due to trauma. It remains unclear whether the morphological changes following trauma differ from those caused by chronic overload. The aim of this study was (1) to analyze whether a relationship exists between the injury pattern and foot deformity and (2) to evaluate whether there is a distinction between trauma-related and non-trauma-related injuries. Method: We prospectively enrolled 198 patients with a median age of 57 years (range, 13 to 86 years; female, 127 (64%); male, 71 (36%)) who had a clinically diagnosed, surgically confirmed, and classified SL injury. We used weight-bearing standard X-rays to assess foot deformity. The control group consisted of 30 patients (median age 51 years, range, 44-66; female, 21 (70.0%); male, 9 (30.0%)) with no foot deformities or prior foot surgeries. Results: A 41.9% incidence of trauma was identified as the cause of these injuries, accounting for 16 (20.8%) of isolated injuries to the SL, 30 (42.9%) of SL injury accompanied by a posterior tibial (PT) tendon avulsion, and 37 (72.5%) of SL injury alongside a bony avulsion at the navicular injuries. The odds of being post-traumatic decreased with each year of age by a factor of 0.97 (95% CI: 0.95-0.99). Conclusions: While all radiographic measurements for flatfoot deformity became pathological after an injury to the SL, they did not accurately predict the injury patterns of the SL and distal PT tendon. Generally, post-traumatic cases exhibited lower severity of foot deformity, suggesting that other structures beyond the SL may contribute to the development of flatfoot deformity.
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NewsBot · Aug 24, 2025

Description of Anatomical Differences in 3D Bone Morphology Between Female Individuals with Progressive Collapsing Foot Deformity and Asymptomatic Controls
Takuma Miyamoto et al
J Foot Ankle Surg. 2025 Aug 21:S1067-2516(25)00234-0.

Background: Progressive collapsing foot deformity (PCFD) represents a multifaceted three-dimensional condition. However, there has been limited discussion regarding how the morphology of each bone affects PCFD.

Purpose: To determine morphological differences within each bone of the foot and ankle in females affected by PCFD compared to asymptomatic controls.

Study design: Comparative cross-sectional study METHODS: We hypothesized the medial column bones would exhibit the most substantial shape differences between groups. We developed multiple statistical shape models (SSMs) to analyze the 3D shape of the distal tibia, distal fibula, talus, calcaneus, navicular, cuboid, cuneiforms, and metatarsals. We quantified and compared results between 23 female PCFD patients and 23 asymptomatic females.

Results: SSM analyses revealed significant modes of variation across several bones. Notably, the fibula showed reduced fibular tip height in PCFD patients. The talus exhibited decreased lateral and posterior processes and an inferior, adducted talar head shift. The calcaneus had a narrowed posterior facet and anteriorly shifted anterior-medial facet. In PCFD patients, the navicular tuberosity was displaced toward the body with medial-inferior articular defects. The cuboid showed increased prominence of the tuberosity and beak.

Conclusion: These SSM results provide novel characterization of the 3D shape of bones from tibia to metatarsals in PCFD and asymptomatic females. Patients with PCFD exhibited distinct 3D shape differences in the distal fibula, talus, calcaneus, navicular, and cuboid, suggesting that PCFD is primarily characterized by deformities of the hindfoot bones.
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NewsBot · Sep 15, 2025

An All-Female Study Quantifying Morphological Differences of the Hindfoot and Posterior Tibialis Muscle Between Patients with Progressive Collapsing Foot Deformity and Asymptomatic Controls
Takuma Miyamoto et al
JB JS Open Access. 2025 Sep 17;10(3):e24.00215.

Background: The posterior tibialis (PT) muscle and tendon could be a contributing factor in progressive collapsing foot deformity (PCFD). Still, the extent to which the function of the PT is related to PCFD progression is debated. Recently, statistical shape models (SSM) have been shown to provide more accurate and comprehensive morphological evaluations of musculoskeletal tissue. To enhance understanding of the PT in patients with PCFD, we used a 3D SSM to test the hypothesis that both the shape of the PT and alignment of the PT relative to the hindfoot bones are different in female patients with PCFD when compared with female asymptomatic controls.

Methods: In this retrospective comparative study, 12 female patients presenting with PCFD and 19 female asymptomatic individuals were included. Computed tomography images were segmented to create 3D models of hindfoot bones and PT. We compared the shape of the PT and alignment of the PT with the hindfoot bones using SSM. The PT 3D model was also used to measure volume, tendon normalized length, and percentage fat of the PT muscle. Each measurement and SSM were compared between PCFD and asymptomatic controls.

Results: SSM did not identify significant differences in the isolated shape of the PT between groups. However, the SSM showed significant differences in the alignment of PT tendon regarding the hindfoot bones. Tendon normalized length was significantly lower in PCFD than that in controls. Percent fat content was significantly higher in PCFD compared with controls. No significant differences were found for PT volume between both groups.

Conclusion: Our results indicate that in female patients with PCFD, the PT does not differ significantly in shape and volume, only in tendon alignment relative to hindfoot bones, suggesting that the PT may be not always directly involved in the progression of PCFD.

Clinical relevance: The application of SSM to assess bones and muscles simultaneously in female patients with PCFD is a new and novel approach to understanding the pathophysiology of this disease.
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NewsBot · Sep 24, 2025

MRI Evaluation of Cervical, Spring, and Interosseous Talocalcaneal Ligament Orientation in Progressive Collapsing Foot Deformity
Alexander Chang et al
Foot Ankle Int. 2025 Sep 23:10711007251363927.

Background: Progressive collapsing foot deformity (PCFD) is a complex condition characterized by progressive ligamentous and osseous changes in the hindfoot, midfoot, and forefoot. Although osseous changes at the subtalar and transverse tarsal joints have been well studied, ligamentous anatomy in PCFD is less understood. This study evaluates the cervical, interosseous talocalcaneal, and superomedial fibers of the spring ligament in patients with PCFD vs controls using magnetic resonance imaging (MRI) analysis.

Methods: Nonweightbearing MRI and weightbearing radiographs of 39 patients (23 PCFD, 16 controls) were retrospectively reviewed. MRIs measured the coronal plane orientation of the interosseous talocalcaneal, cervical, and superomedial spring ligaments relative to the subtalar joint middle facet. Radiographic data included anteroposterior (AP) talonavicular coverage percentage, AP talocalcaneal angle (Kite), lateral talar-first metatarsal angle (Meary), talar declination angle, and calcaneal pitch. Two observers measured each radiographic and MRI angle. Statistical analysis included an independent t test and intraclass correlation coefficient (ICC) to assess interobserver reliability.

Results: PCFD patients demonstrated significantly more horizontal ligament orientations than controls, with reduced cervical (25.5 vs 45 degrees, P < .001), superomedial spring (11.5 vs 23.1 degrees, P < .001), and interosseous talocalcaneal ligament angles (39.5 vs 49.0 degrees, P = .005). Radiographically, PCFD patients had decreased talonavicular coverage (64.5% vs 80.9%, P < .001), increased Meary angle (22.2 vs -2.3 degrees, P < .001), increased talar declination (37.0 vs 20.6 degrees, P < .001), increased Kite angle (20.7 vs 17.2 degrees, P = .079), and decreased calcaneal pitch (15.5 vs 24.6 degrees, P < .001). Interobserver reliability was excellent, with ICC values exceeding 0.94 for all measurements except interosseous talocalcaneal ligament angle (ICC = 0.83).

Conclusion: On nonweightbearing MRI, PCFD patients showed more horizontal orientation of key subtalar ligaments than controls; whether these differences persist under physiologic load should be confirmed with weightbearing imaging.
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NewsBot · Oct 28, 2025

Deltoid Ligament Insufficiency in Hindfoot Arthrodesis for Progressive Collapsing Foot Deformity: A Retrospective Analysis
Arina Litarov et al
Source

Background
In advanced stages of progressive collapsing foot deformity, attenuation of the deltoid ligament can contribute to valgus tilt of the talus within the ankle mortise. Hindfoot arthrodesis is the standard treatment for late-stage progressive collapsing foot deformity; however, unrecognized deltoid ligament insufficiency may predispose patients to postoperative tibiotalar valgus.
Purpose
To evaluate the accuracy of preoperative MRI in detecting deltoid ligament insufficiency in patients undergoing hindfoot arthrodesis for late-stage PCFD.
Study Design/Methods
37 feet from 35 patients undergoing arthrodesis for advanced PCFD were reviewed. Preoperative MRI findings were compared to intraoperative valgus stress radiographs. Sensitivity, specificity, and odds ratio for MRI detecting deltoid incompetence were calculated.
Results
Deltoid ligament disruption occurred in 18.9% (7/37) of cases as confirmed by both MRI and intraoperative stress testing. 35.1% (13/37) had a negative MRI but a positive stress exam. An additional 10.8% (4/37) had MRI-positive findings unconfirmed by stress test. Overall, 54.1% (20/37) demonstrated deltoid ligament insufficiency in intraoperative stress examination. MRI identified deltoid tears in 29.7% (11/37) of cases, yielding a sensitivity of 63.6% and specificity of 50.0%. The odds ratio of a positive MRI predicting actual deltoid ligament insufficiency was 1.75.
Conclusion
MRI as a standalone modality demonstrated limited accuracy in detecting functionally significant deltoid laxity. Functional deltoid incompetence should be considered in surgical planning, and adjunctive intraoperative assessments should be performed to confirm deltoid instability. Prospective studies are needed to determine the best method of reducing the incidence of postoperative tibiotalar valgus.
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NewsBot · Nov 8, 2025

Acute Posterior Tibial Tendon Rupture Can Induce a Rapid Development of Progressive Collapsing Foot Deformity: A Case Report
Alexander Chang , Avinaash Korrapati, Ian Foran
https://pubmed.ncbi.nlm.nih.gov/41171964/

Case: A 78-year-old woman presented to the clinic with right medial foot and ankle pain with an associated new-onset, planovalgus foot after a fall descending stairs. Preinjury imaging demonstrated an intact posterior tibial tendon (PTT) and normal alignment of the foot. Postinjury imaging revealed PTT rupture and classic features of progressive collapsing foot deformity (PCFD).

Conclusion: This report provides rare chronologic insight that enhances the understanding of tendon-driven PCFD and how PTT rupture can precipitate a rapid progression in deformity. Early recognition of a PTT injury may be essential to mitigating the rapid onset and progression of PCFD.
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Structures involved in posterior tibial tendon dysfunction

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Personality Traits linked to Foot Structures

"Haleem’s Hen"; A mnemonic for the anatomy of hindfoot structures

A New Classification of Foot Structures Based on Foot Embryology is proposed

Palpation Skills in Foot and Ankle Anatomic Structures

A New Classification of Foot Structures Based on Foot Embryogenesis

which structures are in dysfunctions in LAS or CAI?

A comparison of foot kinetic parameters between pronated and normal foot structures during forward j

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Structures involved in posterior tibial tendon dysfunction

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Personality Traits linked to Foot Structures

"Haleem’s Hen"; A mnemonic for the anatomy of hindfoot structures

A New Classification of Foot Structures Based on Foot Embryology is proposed

Palpation Skills in Foot and Ankle Anatomic Structures

A New Classification of Foot Structures Based on Foot Embryogenesis

which structures are in dysfunctions in LAS or CAI?

A comparison of foot kinetic parameters between pronated and normal foot structures during forward j

Share This Page

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