The posterior deep deltoid ligament (posterior tibiotalar ligament) is the deepest and strongest component of the deltoid ligament complex, running from the posterior colliculus of the medial malleolus to the posteromedial talar body. It is the primary restraint to external talar rotation.
| Origin | Posterior colliculus and intercollicular groove of the medial malleolus |
|---|---|
| Insertion | Medial surface of the talus and its medial tubercle |
Primary restraint to talar external rotation and posterior talar displacement; resists valgus tilt; the strongest component of the deltoid ligament.
The posterior deep deltoid is the last deltoid component to tear in progressive eversion injuries and is the critical structure assessed in medial ankle instability after bimalleolar or trimalleolar fractures. Its tear allows the talus to shift laterally, seen as medial clear space widening on stress radiographs. In many ankle fractures, anatomical fibular fixation restores the mortise and lets the deep deltoid heal without direct repair, but direct repair is considered when the mortise stays unstable or in fracture-dislocations. MRI demonstrates posterior deep deltoid tears at the malleolar attachment.
Disruption of the posterior deep deltoid ligament in bimalleolar equivalent fracture producing medial instability with a widened medial ankle space on stress views, requiring repair or ligament reconstruction alongside fibular fixation.
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