The deep posterior tibiotalar component of the deltoid ligament is the strongest and deepest portion of the complete deltoid complex, connecting the posterior colliculus of the medial malleolus to the posteromedial talar body.
Primary medial ankle stabiliser — resists lateral talar tilt and external rotation. The dominant deltoid component providing the deep medial constraint of the tibiotalar joint.
Deep deltoid tears in ankle fractures allow medial clear space widening on stress X-ray. Repair is generally not required when lateral fixation achieves mortise reduction, but direct repair improves medial stability in complex fracture-dislocations.
Widened medial clear space on stress radiograph from deep deltoid disruption indicating medial ankle instability, managed by lateral fixation with assessment for direct deltoid repair.
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