The posterior deep tibiotalar ligament is the largest and strongest deltoid component, running from the posterior colliculus of the medial malleolus to the posterior medial talus.
The primary medial ankle stabiliser — resists talar lateral displacement, external rotation, and eversion. The medial constraint corresponding to the lateral ankle ligament complex.
The most important deltoid component to restore in medial ankle instability. In bimalleolar fractures, accurate lateral malleolus fixation indirectly tensions the deep deltoid, making direct repair unnecessary in most cases.
Deep tibiotalar deltoid disruption producing medial talar displacement, requiring lateral fixation with assessment for direct deltoid repair if instability persists.
Direct deep deltoid repair in fractures with medial soft tissue disruption reducing late medial ankle pain and talar tilt.
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