Medial Ankle Instability: The Deltoid Dilemma.

Diagnosis and treatment of medial ankle instability (MAI) are still controversial and poorly discussed in literature. The purpose of this review is to highlight different clinical presentations of MAI and develop a guide for its management. The deltoid ligament complex is injured more commonly than expected, because deltoid ligament injuries may either be isolated or occur in combination with other lesions, such as lateral ankle ligament injury, posterior tibial tendon insufficiency, osteochondral lesion, and others. The presence of a pes planovalgus deformity in a patient without posterior tibial tendon insufficiency may indicate MAI.

• Publication year

  2018

• Venue

  Foot and Ankle Clinics

• Publication date

  2018-12-01

• Fields of study

  Medicine

• Identifiers
  DOI 10.1016/j.fcl.2018.07.008PMID 30414658
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

• Medial-sided Ankle Pain: Deltoid Ligament and Beyond.

  2017cited by this paper
• Ankle instability: Anatomy, mechanics, management and sequelae

  2017cited by this paper
• Anatomical Lateral and Medial Ligament Reconstruction in Rotational Chronic Ankle Instability

  2016cited by this paper
• Anatomical ligament reconstruction in rotational chronic ankle instability

  2016cited by this paper
• Repair of the acute deltoid ligament complex rupture associated with ankle fractures: a multicenter clinical study.

  2015cited by this paper
• Deltoid Ligament and Tibiofibular Syndesmosis Injury in Chronic Lateral Ankle Instability: Magnetic Resonance Imaging Evaluation at 3T and Comparison with Arthroscopy

  2015cited by this paper
• Chronic Rotational Ankle Instability- A case series study

  2015cited by this paper
• Chronic Ankle Instability (Medial and Lateral).

  2015cited by this paper
• Ankle sprains and instability.

  2014cited by this paper
• Consensus in chronic ankle instability: aetiology, assessment, surgical indications and place for arthroscopy.

  2013cited by this paper
• Reconstruction of Osteochondral Lesions of the Talus With Autologous Spongiosa Grafts and Autologous Matrix-Induced Chondrogenesis

  2013cited by this paper
• Accuracy of MRI findings in chronic lateral ankle ligament injury: comparison with surgical findings.

  2012cited by this paper
• A Novel Imaging Method for Osteochondral Lesions of the Talus—Comparison of SPECT-CT With MRI

  2011cited by this paper
• Deltoid Ligament Abnormalities in Chronic Lateral Ankle Instability

  2011cited by this paper
• Ultrasonography as a diagnostic tool in assessing deltoid ligament injury in supination external rotation fractures of the ankle.

  2011cited by this paper
• Is MRI Adequate to Detect Lesions in Patients with Ankle Instability?

  2010cited by this paper
• Deltoid Ligament Reconstruction with Peroneus Longus Autograft in Flatfoot Deformity

  2010cited by this paper
• Etiology of Ankle Osteoarthritis

  2009cited by this paper
• Comparison of two intraoperative assessment methods for injuries to the ankle syndesmosis. A cadaveric study.

  2009cited by this paper
• Frontal and lateral characteristics of the osseous configuration in chronic ankle instability

  2008cited by this paper
• The biomechanical influence of tibio-talar containment on stability of the ankle joint

  2007cited by this paper
• The effect of osseous ankle configuration on chronic ankle instability

  2007cited by this paper
• Ligamentous Posttraumatic Ankle Osteoarthritis

  2006cited by this paper
• Diagnostik und Therapie der medialen Sprunggelenkinstabilität

  2005cited by this paper
• Reconstruction of the Chronically Failed Deltoid Ligament: A New Technique

  2004cited by this paper
• Medial Ankle Instability

  2004cited by this paper
• Nonoperative treatment of adult acquired flat foot with the Arizona brace.

  2003cited by this paper
• High‐intensity training with a bi‐directional bicycle pedal improves performance in mechanically unstable ankles – a prospective randomized study of 19 subjects

  2003cited by this paper
• Diagnosis of a tear of the tibiofibular syndesmosis. The role of arthroscopy of the ankle.

  2003cited by this paper
• Medial ankle instability.

  2003cited by this paper
• Syndesmosis injuries in the athlete: when and how to operate

  2002cited by this paper
• Anatomical Study of the Medial Ankle Ligament Complex

  2002cited by this paper
• Commentary: Functional Ankle Instability Revisited.

  2002cited by this paper
• Ultrasonography of ankle ligaments.

  2002cited by this paper
• Peroneal Reaction Times and Eversion Motor Response in Healthy and Unstable Ankles.

  2002cited by this paper
• Arthroscopic Findings in Patients with Chronic Ankle Instability

  2002cited by this paper
• Do type B malleolar fractures need a positioning screw?

  2002cited by this paper
• Proprioception and Muscle Strength in Subjects With a History of Ankle Sprains and Chronic Instability.

  2002cited by this paper
• A multi-station proprioceptive exercise program in patients with ankle instability.

  2001cited by this paper
• Functional instability in non-contact ankle ligament injuries

  2000cited by this paper
• Associated Injuries Found in Chronic Lateral Ankle Instability

  2000cited by this paper
• Competence of the Deltoid Ligament in Bimalleolar Ankle Fractures After Medial Malleolar Fixation*

  2000cited by this paper
• Lengthening of the Lateral Column and Reconstruction of the Medial Soft Tissue for Treatment of Acquired Flatfoot Deformity Associated with Insufficiency of the Posterior Tibial Tendon

  1999cited by this paper
• The Medial Collateral Ligaments of the Human Ankle Joint: Anatomical Variations

  1998cited by this paper
• Persistent Disability Associated with Ankle Sprains: A Prospective Examination of an Athletic Population

  1998cited by this paper
• Ankle orthoses effect on single-limb standing balance in athletes with functional ankle instability.

  1998cited by this paper
• Effect of unilateral functional instability of the ankle on postural sway and inversion and eversion strength.

  1997cited by this paper
• [Is surgical treatment of deltoid ligament rupture necessary in ankle fractures?].

  1997cited by this paper
• Evaluation of kinesthetic deficits indicative of balance control in gymnasts with unilateral chronic ankle sprains.

  1996cited by this paper
• Contribution of the Deltoid Ligament to Ankle Joint Contact Characteristics: A Cadaver Study

  1996cited by this paper
• Ankle taping improves proprioception before and after exercise in young men.

  1995cited by this paper
• Influence of Ligament Transection on Tibial and Calcaneal Rotation with Loading and Dorsi-Plantarflexion

  1995cited by this paper
• Reconstruction of a severe grinding injury to the medial malleolus and the deltoid ligament of the ankle using a free plantaris tendon graft and vascularized gracilis free muscle transfer: case report.

  1994cited by this paper
• Articular cartilage lesions in ankles with lateral ligament injury

  1993cited by this paper
• The stabilizing effect of the ligamentous structures in the sinus and canalis tarsi on movements in the hindfoot

  1988cited by this paper
• The deltoid ligament. An evaluation of need for surgical repair.

  1988cited by this paper
• Fracture-dislocation of the ankle with rupture of the deltoid ligament.

  1988cited by this paper
• Results of operative treatment of displaced external rotation-abduction fractures of the ankle.

  1985cited by this paper
• The stability of the tibio-fibular syndesmosis following rigid internal fixation for type C malleolar fractures: an experimental and clinical study.

  1983cited by this paper
• Anatomical basis of variability in injuries of the medial malleolus and the deltoid ligament. I. Anatomical studies.

  1979cited by this paper
• Changes in tibiotalar area of contact caused by lateral talar shift.

  1976cited by this paper
• Sprained ankles. VI. Surgical treatment of "chronic" ligament ruptures.

  1966cited by this paper
• The etiology and prevention of functional instability of the foot.

  1965cited by this paper
• Instability of the foot after injuries to the lateral ligament of the ankle.

  1965cited by this paper
• Widening of the ankle mortise. A clinical and experimental study.

  1960cited by this paper
• Widening of the ankle mortise. A clinical and experimental study.

  1960cited by this paper
• Some applications of the functional anatomy of the ankle joint.

  1956cited by this paper

• Advancements in minimally invasive treatment of deltoid ligament injuries combined with distal tibiofibular syndesmosis injuries

  2025cites this paper
• Impact of systematic ultrasonography on lateral ankle sprain management.

  2025cites this paper
• Preliminary Development of an Opto-Electronic System for Ankle Instability Assessment

  2025cites this paper
• Arthroscopic Deltoid Ligament Surgery in Ankle Disorders: A Review

  2025cites this paper
• The Lateral Calcaneal Lengthening Osteotomy (LCLOT)—A Contemporary Review

  2025cites this paper
• Arthroscopic Deltoid Ligament Repair as a Potential Alternative Treatment for Ankle Deltoid Ligament Injury

  2025influential citation
• Postoperative Imaging of the Ankle: Ligament and Tendon Reconstruction

  2025cites this paper
• Recent advances in the management of chronic ankle instability

  2024cites this paper
• Progress in Diagnosis and Treatment of Triangular Ligament Injury

  2024cites this paper
• A Review of Chronic Lateral Ankle Instability and Emerging Alternative Outcome Monitoring Tools in Patients following Ankle Ligament Reconstruction Surgery

  2024cites this paper
• Multidirectional Chronic Ankle Instability: What Is It?

  2023cites this paper
• Incidence of Medial Deltoid Ligament Instability in 226 Patients with Chronic Ankle Instability.

  2023cites this paper
• A clinical guide to the medial ligaments of the ankle: Anatomy, function, diagnosis of injuries and treatment of instability-a narrative review.

  2023cites this paper
• Bone marrow edema at ligament insertion is an accurate MRI sign of deltoid ligament injury

  2023cites this paper
• Morphological classification and clinical significance of medial malleolus based on computed tomography three-dimensional reconstruction

  2023cites this paper
• Ankle Instability Update

  2023cites this paper
• Sprain of the Medial Ankle Ligament Complex.

  2023cites this paper
• Evaluation of the heel external rotation test in soft tissue deficiencies associated with adult acquired flatfoot deformity (AAFD). A cadaver sectioning analysis.

  2023cites this paper
• Management in Stage IV Adult-acquired Flatfoot Deformity

  2022cites this paper
• Ultrasound Examination of the Ligament Complex Within the Medial Aspect of the Ankle and Foot

  2022influential citation
• An Update on Posterior Tarsal Tunnel Syndrome.

  2022cites this paper
• Treatment of the Deltoid and Syndesmotic Ligaments in Chronic Ankle Instability

  2022cites this paper
• Pediatric Musculoskeletal Injuries.

  2022cites this paper
• Prediction of anterior tibiotalar ligament injury: measurement of the angle between the deep posterior tibiotalar ligament and talus on MRI

  2022cites this paper
• Isolated, periosteal stripping injuries of the Flexor Retinaculum: Case series of 3 patients with clinico-radiological review.

  2022cites this paper
• Presurgical Perspective and Postsurgical Evaluation of Instability and Microinstability Secondary to Ankle Ligaments Injury

  2022cites this paper
• Medial Ankle Instability (Including Spring Ligament)

  2021cites this paper
• Medial and Lateral Combined Ligament Arthroscopic Repair for Multidirectional Ankle Instability

  2021cites this paper
• Morphological classification and clinical significance of medial malleolus based on CT three-dimensional reconstruction.

  2021cites this paper
• Deltoid Ligament Insufficiency

  2021cites this paper
• Ankle instability – review and new trends

  2021cites this paper
• Vantage Total Ankle Replacement

  2021cites this paper
• Spring and Deltoid Ligament Insufficiency in the Setting of Progressive Collapsing Foot Deformity. An Update on Diagnosis and Management.

  2021cites this paper
• Ankle and syndesmosis instability: consensus and controversies

  2021cites this paper
• Arthroscopic All-Inside Anterior Talofibular Ligament Repair with and without Inferior Extensor Retinacular Reinforcement

  2021cites this paper
• Clinical Appearance of Medial Ankle Instability.

  2021cites this paper
• Imaging of Peritalar Instability.

  2021cites this paper
• State of the Art in Treatment of Chronic Medial Ankle Instability.

  2021cites this paper
• Quantitative Analysis of Deltoid Ligament Degradation in Patients With Chronic Ankle Instability Using Computed Tomographic Images

  2021cites this paper
• The Failed Deltoid Ligament in the Valgus Misaligned Ankle-How to Treat?

  2021cites this paper
• Deltoid and spring ligament lesions in flat foot treatment

  2020cites this paper
• Technique for Arthroscopic Deltoid Ligament Repair With Description of Safe Zones

  2020cites this paper
• Ankle Joint

  2020cites this paper
• Deltoid ligament reconstruction with autologous gracilis tendon in chronic medial ankle instability after ankle fracture surgery: A case report.

  2020cites this paper
• Diagnosis and Treatment of Chronic Ankle Instability

  2019cites this paper
• Is This My Ankle or My Foot?

  2017cites this paper
• MANAGEMENT STRATEGIES FOR ANKLE SPRAINS: A NARRATIVE REVIEW

  year unknowncites this paper
• World Journal of Orthopedics

  year unknowncites this paper
• MISSED MEDIAL MALLEOLUS FRACTURE WITH DELTOID LIGAMENT INJURY AND INSTABILITY, TREATED NON OPERATIVELY - A CASE BASED DISCUSSION & LITERATURE REVIEW

  year unknowncites this paper