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Tibialis Posterior Tendon — Spring Ligament Complex

tendo musculi tibialis posterioris (complexus cum ligamento calcaneonaviculari)

The tibialis posterior tendon's expansion onto the spring ligament and its insertion on the navicular create a functional unit that dynamically reinforces the static spring ligament support of the talar head. PTTD disrupts both the tendon and the spring ligament simultaneously — the combined dynamic-static failure produces the progressive flatfoot deformity. Spring ligament insufficiency cannot be corrected by tendon reconstruction alone.

Region: Foot & Ankle

Biomechanics

Function & Actions

Dynamic arch support through the spring ligament reinforcement; the primary dynamic stabiliser of the medial longitudinal arch

Clinical Relevance

Clinical Notes

The tibialis posterior-spring ligament complex is assessed as a unit on MRI — both structures are evaluated on coronal MRI of the medial ankle. Stage II PTTD flatfoot reconstruction addresses both the tendon (FDL transfer to replace PTTD function) and the spring ligament (direct repair or reconstruction) alongside the calcaneal osteotomy.

Pathology

Common Injuries & Conditions

PTTD with Spring Ligament Tear

Combined tibialis posterior tendon and spring ligament disruption producing flatfoot managed with FDL transfer and spring ligament reconstruction.