Deltoid ligament repair and augmentation using the posterior tibial tendon during hindfoot arthrodesis in Progressive Collapsing Foot Deformity: A novel technique

Introduction

Progressive Collapsing Foot Deformity (PCFD), or Adult Acquired Flatfoot Deformity (AAFFD), leads to medial longitudinal arch collapse and ankle instability, with deltoid ligament insufficiency exacerbating valgus talar tilt. Despite multiple reconstruction methods, an optimal approach remains elusive.

Technique

This study presents a novel technique for deltoid ligament repair and augmentation using the posterior tibial tendon (PTT) in patients undergoing hindfoot arthrodesis for PCFD. A medial approach is used for both hindfoot fusion and PTT harvesting. The tendon is split into superior and inferior arms, which are utilized to reinforce the tibionavicular and tibiocalcaneal bands. Nonabsorbable sutures and suture anchors secure fixation, while hindfoot fusion is completed using cannulated screws. Postoperative weight-bearing is gradually advanced.

Discussion

This technique improves medial ankle stability while preserving native deltoid ligament tissue. By augmenting the ligament with the PTT, it avoids the risks associated with allografts and donor site morbidity. Preliminary intraoperative and radiographic findings show enhanced coronal and sagittal stability, indicating potential benefits in restoring ankle alignment and function. This novel augmentation strategy offers a promising alternative for managing medial ankle instability in PCFD patients undergoing hindfoot fusion. However, further studies comparing its long-term outcomes to other techniques are essential to validate its efficacy.