Stage IV Adult-Acquired Flatfoot Deformity Deltoid Ligament Reconstruction

Patients with flexible stage IV flatfoot present with valgus ankle deformity in addition to medial arch collapse, resulting in hind foot valgus and midfoot abduction. The ankle deformity is best addressed at the time of flatfoot reconstruction. In this article, we describe a method of reconstructing the deltoid ligament complex by using an Achilles allograft tendon. The graft is prepared with a bone block that is placed in a talar tunnel and secured to a screw post in the lateral talar body. The graft is passed through an oblique tibial tunnel, drilled from medial to lateral starting at the medial malleolus and exiting out the lateral tibia above the level of the ankle. The reconstruction is indicated in cases in which ankle valgus can be passively reduced and there is no bone on bone contact in the ankle joint. A previous report showed promising results in a small cohort of patients using a peroneus longus autograft.