The deltoid ligament is the medial ankle ligament complex, consisting of a superficial layer (tibionavicular, tibiocalcaneal, posterior tibiotalar superficial components) and a deep layer (anterior and posterior tibiotalar deep components). Together they provide the primary medial ankle stability.
Primary medial ankle stabiliser — resists eversion, external rotation, and lateral talar displacement. The deep deltoid is the dominant component, preventing lateral talar tilt. The superficial deltoid restrains calcaneal eversion.
The deltoid ligament is more resistant to injury than the lateral ligaments — isolated deltoid sprains are less common than lateral ankle sprains. In bimalleolar fractures, the deltoid may remain intact (replaced by a medial malleolus fracture) or be torn (true bimalleolar equivalent). Persistent medial ankle pain after ankle fracture suggests deltoid injury requiring surgical repair.
Complete medial deltoid disruption from forced eversion producing medial ankle swelling and instability to valgus stress, requiring assessment with stress radiographs and managed by repair in unstable cases.
Intact deltoid in medial clear space evaluation on stress radiograph indicates adequate medial stability, potentially allowing non-operative management of certain lateral malleolus fractures.
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