The deltoid is a powerful fan-shaped ligament complex on the medial ankle connecting the medial malleolus to the talus, calcaneus, and navicular, providing primary restraint against eversion and external rotation. It has a superficial layer (tibionavicular, tibiospring, tibiocalcaneal, and superficial posterior tibiotalar bands) and a deep layer (anterior and posterior tibiotalar ligaments). It is much stronger than the lateral ankle ligaments, so eversion forces often fracture the medial malleolus rather than tear the deltoid.
| Origin | Medial malleolus (anterior and posterior colliculi) |
|---|---|
| Insertion | Navicular tuberosity, spring ligament, sustentaculum tali of the calcaneus and medial surface of the talus |
Prevents the talus from externally rotating and everting beneath the tibia, the principal medial ankle stabiliser.
Deltoid injuries are less common than lateral sprains but potentially more disabling. Combined with a fibular fracture, a deltoid tear produces bimalleolar-equivalent instability requiring careful assessment. Incompetence is shown by a medial clear space greater than about 4 mm on stress radiographs. Many fracture-related deltoid tears heal once the fibula is anatomically fixed, while persistent widening or fracture-dislocation may need direct repair.
Eversion or external rotation injury producing medial ankle pain and swelling, less common than lateral sprains but more significant given the deltoid's stabilising role.
Complete deltoid tear with a fibular fracture (bimalleolar-equivalent injury) allowing the talus to shift laterally, managed by fibular fixation with deltoid repair when instability persists.
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