Elena Gallardo MD, PhD, Presenter: Nothing to Disclose

Rosa Maria A. Landeras MD, Abstract Co-Author: Nothing to Disclose

Eduardo Torres Diez, Abstract Co-Author: Nothing to Disclose

Rosario Garcia Barredo, Abstract Co-Author: Nothing to Disclose

Rosa De La Puente, Abstract Co-Author: Nothing to Disclose

Gerardo Lopez Rasines MD, Abstract Co-Author: Nothing to Disclose

To assess the role of the calcaneonavicular ligament in the peritalar destabilization in patients with acquired flat foot deformity.

We performed a systematic exploration of the ankle with a high linear array transducer (8-13 MHz), focused on the evaluation of the medial stabilizers, posterior tibial tendon (PTT) and calcaneonavicular ligament or spring ligament complex (SLC), in patients with the diagnosis of acquired flat foot deformity. We evaluated the presence of peritalar destabilization in all patients, measuring the medial talus bone motion from the sitting position to the standing position.

We reviewed 60 cases in 49 patients. Tendinosis ot PTT was visualized only in 59,5% of the ankles, whereas a significant degeneration of the SLC was demonstrated in 87% of the cases The most affected area of the SLC was the distal part of the superomedial component in all cases and we visualized a fibrillar disruption in almost one out of three of the cases. We assessed destabilisation more frequently in cases with both SLC degeneration and PTT tendinosis; additionally, in those patients with clear adduction of the talar head while standing, was more frequent the rupture of the SLC. 

Ultrasound is an accurate technique in the evaluation of the spring ligament, and its signs of degeneration are more frequently visualized than PTT tendinosis in patients with acquired flat foot in their initial phases. Dynamic US is a reliable method for measurement the peritalar desestabilization. 

The radiological literature of the acquired adult flat foot is based on the study of the posterior tibial tendon and PTT insufficiency is considered the main cause of this disorder, however imaging techniques may show no abnormalities in this structure. This study shows that degeneration signs are more frequently visualized in SLC than in PTT, demonstrating the capital importance of this ligament complex on its own, in maintaining the normal alignment and height of the medial longitudinal arch.

Gallardo, E, Landeras, R, Torres Diez, E, Garcia Barredo, R, De La Puente, R, Lopez Rasines, G, Adult Acquired Flat Foot Deformity: Dynamic Ultrasound in the Evaluation of the Stabilizers of the Medial Longitudinal Arch.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14007570.html