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

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.