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Foot and ankle examination
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
Nikhil Nanavati, Nicholas Eastley, Maneesh Bhatia
Deltoid ligament: The deltoid ligament is the primary stabiliser of the medial ankle, resisting excessive hindfoot eversion and external rotation. It is assessed using the eversion stress test. The patient is positioned in a sitting position with the ankle plantigrade. The examiner uses one hand to stabilise the tibia and the other to evert and abduct the heel. Any pain or excessive eversion compared to the contralateral side is suggestive of a deltoid ligament injury.
A to Z Entries
Published in Clare E. Milner, Functional Anatomy for Sport and Exercise, 2019
The medial collateral ligament of the ankle is also known as the deltoid ligament because it is triangular in shape. The deltoid ligament is thick and strong and not divided into discrete bands like the lateral collateral ligaments. However, the medial ligaments of the ankle can also be identified according to the bones that they hold together. The names of the individual components vary slightly depending on which textbook you read, precisely because they are not conveniently separated like the lateral ligaments. The following is the common nomenclature for the components of the deltoid ligament. From anterior to posterior: tibionavicular (part of this ligament also attaches to the talus, referred to as anterior tibiotalar), tibiocalcaneal, and posterior tibiotalar. Since the deltoid ligament is thick and strong, it is not commonly injured. However, the mechanism of injury is the opposite movement to the mechanism of injury of the lateral collateral ligaments: an eversion sprain.
SBA Answers and Explanations
Published in Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury, SBAs for the MRCS Part A, 2018
Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury
The most common ankle sprain is lateral which occurs as a result of excessive inversion of the foot and dorsiflexion of the ankle. The deltoid ligament, also known as the medial ligament of the ankle, is very strong and located at the medial malleolus. Excessive eversion would be the most likely mechanism of injury.
Defining the contemporary epidemiology and return to play for high ankle sprains in the National Football League
Published in The Physician and Sportsmedicine, 2022
Steven F. DeFroda, Blake M. Bodendorfer, Davis A. Hartnett, John D. Milner, Daniel S. Yang, Zachary S. Silber, Brian Forsythe
Ankle sprains are one of the most prevalent injuries in the National Football League (NFL), second only to knee injuries [1]. High ankle sprains, or syndesmotic injuries, are notorious in professional football players. They take longer to heal than low ankle sprains, leading to prolonged disability and missed playing time [2]. These injuries affect the distal tibiofibular syndesmosis, which is comprised of the anterior-inferior tibiofibular ligament (AITFL), interosseus ligament (IOL), posterior-inferior tibiofibular ligament (PITFL), and inferior transverse ligament [2]. The deltoid ligament confers stability by restricting lateral talar translation, which is often an accompanying injury to syndesmotic injuries [3]. High ankle sprains are more common in high-impact sports, such as football, rugby, or hockey, and remain a persistent source of missed playing time amongst elite athletes [4]. The injury typically results from forced dorsiflexion and external rotation of the foot relative to the ankle and tibia.
Beyond the anterolateral thigh: the descending branch intermuscular septal (DBIS) flap
Published in Journal of Plastic Surgery and Hand Surgery, 2020
Kareem Hassan, Afaaf Shakir, Jennifer Jaffe, Michael Howard
Approximately three weeks following a right revision total ankle arthroplasty, Achilles tendon lengthening, superficial deltoid ligament reconstruction and lateral ligament reconstruction, a 63-year-old female developed some eschar/demarcation at the distal end of the anterior incision and in the medial skin bridge. She had been discharged to a skilled nursing facility on clindamycin and treated with hyperbaric oxygen therapy until presenting to the plastic surgeon for a consult on wound management. There was concern for exposed tendon and hardware and the patient was taken for debridement. The patient underwent debridement of the right foot and ankle wound, ultimately resulting in exposed joint and tendon (Figure 1). The structures were ultimate covered with a DBIS flap with split-thickness skin graft (Figure 2). Cultures taken at the time of surgery returned negative for any organism growth. She recovered uneventfully and was discharged from the hospital on postoperative day 4. Local wound care was performed at home and physical therapy initiated with regular visits to the plastic surgeon and had resumed all weight bearing activity by two months post-operatively from flap closure (Figure 3).