Reconstruction of the interosseus talocalcaneal ligament in progressive collapsing foot deformity: A review of the literature and description of a novel surgical technique

Background

The Interosseous Talo-Calcaneal Ligament (ITCL) is a key stabilizer of the subtalar joint, essential in preventing talo-calcaneal divergence. Its attenuation significantly contributes to the pathogenesis of Progressive Collapsing Foot Deformity (PCFD). Thus, anatomical reconstruction of the ITCL could offer promise in treating flexible (Stage 1) PCFD, aiming to restore subtalar joint stability and prevent deformity progression. The aim of the present work was to report existing ITCL reconstruction techniques and present a novel approach in PCFD.

Study Design

Current concept and technical note

Methods

A focused current concepts review of existing literature on ITCL reconstruction was performed to identify opportunities and existing gaps. Subsequently, we introduced a novel surgical technique for anatomically reconstructing the ITCL, spring ligament, and superficial deltoid ligament complex using a semitendinosus allograft. Dedicated targeting guides were employed to ensure precise identification and accurate placement of ligament attachment sites.

Results

Current literature primarily discusses ITCL reconstruction within the context of subtalar instability associated with Chronic Lateral Ankle Instability (CLAI). However, no prior method has explicitly addressed ITCL reconstruction for managing PCFD, which constitutes a significant gap in the literature. We describe a novel surgical technique to address ITCL reconstruction in flexible (Stage 1) PCFD.

Conclusion

ITCL reconstruction the logical next step in conservative treatment of flexible PCFD with peritalar subluxation (class D), to circumvent the need for joint-sacrificing procedures. A novel surgical procedure is presented. Further clinical studies are warranted to evaluate the radiographic and patient-reported outcomes of ITCL reconstruction.