The medial talocalcaneal ligament runs from the posteromedial talus (medial tubercle) to the sustentaculum tali of the calcaneus, passing along the medial aspect of the posterior subtalar joint. It blends with the medial ankle capsule and the deltoid ligament posteriorly, providing medial subtalar stability. The posterior tibial tendon runs in close proximity on its medial surface.
| Origin | Medial tubercle of the posterior process of the talus |
|---|---|
| Insertion | Sustentaculum tali and medial surface of the calcaneus |
Provides medial stability to the subtalar joint, limits subtalar supination and internal rotation, and supports the medial longitudinal arch in conjunction with the spring ligament and deltoid complex.
The medial talocalcaneal ligament is part of the medial ankle stabilising complex that progressively fails in stage II and III posterior tibial tendon dysfunction (PTTD). MRI demonstrates medial talocalcaneal ligament attenuation or tearing as a component of the medial ankle ligamentous failure in advanced flatfoot. In medial ankle reconstruction for PTTD, the medial talocalcaneal ligament is repaired or reinforced alongside spring ligament repair and calcaneal osteotomy. It is approached through the same medial hindfoot incision used for TPT surgery.
Progressive attenuation of the medial talocalcaneal ligament as part of the medial ankle destabilisation in PTTD stage III allows subtalar valgus and external rotation, contributing to the flatfoot deformity; surgical reconstruction addresses the spring ligament and medial talocalcaneal ligament alongside calcaneal osteotomy and possible arthrodesis for the rigid deformity.
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