Spring Ligament Repair With Suture Tape Augmentation

Flatfoot undergoing concomitant posterior tibial tendon (PTT) reconstruction with torn spring ligament

Sag at the level of the talonavicular joint

As an adjunct to medial column osteotomy and lateral column lengthening (if indicated)

Obtain anteroposterior (AP), lateral, and oblique views of the foot to assess for uncoverage and talonavicular overhang. It is also recommended to obtain AP/lateral views of the ankle to assess deltoid integrity ( Fig. 31.1 ).

Magnetic resonance imaging is also obtained, as necessary.

Intraoperative examination is recommended, as necessary.

The spring ligament gives restraint to excessive motion of the talonavicular joint.

The superomedial calcaneonavicular ligament is the largest and strongest component and includes the medial talonavicular capsule. Its origin is the superomedial aspect of sustentaculum tali and anterior facet of the calcaneus. The insertion is the edge of the navicular facet.

The inferior (plantar) calcaneonavicular ligament is a narrower, fibrous structure. The origin is the anterior aspect of the sustentaculum tali, and the insertion is the inferior surface of the middle of the navicular.

The third ligament is also a contributor. It originates from the notch between the anterior and middle calcaneal facets and inserts onto the navicular tuberosity.