Spring ligament reconstruction in posterior tibial tendon insufficiency

摘要

Posterior tibial tendon insufficiency is characterized by the attenuation or degeneration of the dynamic and static supports of the foot and ankle. Flatfoot deformities have been divided into four different stages. Stage IIb deformity, a severe flexible flatfoot, is characterized by talonavicular uncoverage greater than or equal to 30%. The spring ligament complex provides the main static support of the medial longitudinal arch. At this stage of deformity, it is usually degenerated or attenuated and may even have a full-thickness tear. Bony procedures alone may not be sufficient to bring the forefoot out of abduction, leaving the foot susceptible to failure or recurrent collapse. Surgical treatment for this stage is controversial. Arthrodeses or osteotomies alone can severely limit motion or be inadequate to correct the deformity. A reconstruction of the spring ligament has been suggested to restore the static support of the foot. To date, there is a paucity of current literature on reconstruction of the spring ligament, but advancements are being made.