Spring Ligament Reconstruction for Advanced Flatfoot Deformity with the Use of an Achilles Allograft

Patients with flexible flatfoot can present with a variety of deformities, including heel valgus, medial arch collapse, and midfoot abduction. The spring (calcaneonavicular) ligament plays a major role in stabilizing the medial longitudinal arch. Its compromise, when severe enough and accompanied by failure of other ligaments, is manifested by talonavicular collapse on lateral radiographs along with uncoverage of the talar head by the navicular on anteroposterior radiographs. In this article, we describe a method of reconstructing the spring ligament complex by using an Achilles allograft. This reconstruction is indicated in cases of severe talonavicular collapse manifested by forefoot abduction that persists despite appropriate lateral column lengthening. The decision to perform such reconstruction is supported by preoperative magnetic resonance imaging demonstrating severe compromise of the spring ligament and confirmed intraoperatively once it is determined that lateral column lengthening provides insufficient correction of the deformity.