The tibialis posterior tendon and spring ligament (plantar calcaneonavicular ligament) function as an integrated support system for the talar head — the spring ligament provides static support and the tibialis posterior provides dynamic reinforcement. Failure of this combined system in adult-acquired flatfoot produces progressive medial arch collapse with talar head medialization and plantar displacement.
Combined dynamic (tibialis posterior) and static (spring ligament) support system for the talar head
The spring ligament repair is now routinely combined with FDL tendon transfer and calcaneal osteotomy in adult-acquired flatfoot reconstruction, recognising that tibialis posterior tendon alone cannot restore arch height without restoring the static spring ligament support. MRI assessment of spring ligament integrity guides the extent of surgical reconstruction needed.
Combined tibialis posterior tendon dysfunction and spring ligament disruption producing adult flatfoot requiring combined tendon transfer, spring ligament repair, and bony correction.
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