Deltoid ligament

[Eve Skaros]

Hi Stephen!

I am currently learning ankle ultrasound and I’m a but stuck on the deltoid ligament. Do you label it as deltoid ligament or label each of the specific ligaments?

Thanks!
Eve

[Stephen Bird]

Hi Eve,

You can label the individual components if you like, but they are all connected in a confluent sheet of collagen as it is simply the medial ankle joint capsule.

To label the individual components simply scan the tibias posterior tendon in short axis.

Start proximal where the tendon is on the tibia (medial malleolus), scan slowly distally with the tib post in short axis and when the tib post leaves the bone of the medial mal it is then sitting on the TIBIOTALAR component of the deltoid. This looks best with eversion and dorsiflexion stress. Then scan further distal and as your transducer arrives at exactly 6 O’clock (straight down) from the medial mal you will see the sustentaculum tali of the calcaneum appear and the collagen connecting the medial mal and the sustentaculum tali is the TIBIOCALCANEAL component (best seen with eversion stress). Continue to follow the tib post in short axis distally and the sustentaculum tali disappears and the talus, covered in hyaline cartilage appears with the spring ligament being the thick layer of the fibrocartilage covering the talus. The collagen commenting the medial mal to the spring ligament is the TIBIOSPRING component (best seen with a little plantar flexion and eversion).
To sweep through these components you need to stay short axis on the tib post tendon and the transducer sweeps around the medial mal. The distal end of the transducer sweeps faster than the proximal end a bit like the hand of a clock sweeping from 5 o’clock (tibiotalar) to 6 o’clock (tibiocalcaneal) to 7 o’clock (tibiospring).

There is a short webinar on this website that deals with this topic. Check out the deltoid ligament assessment webinar.

I hope this explanation helps.

The position of the foot / ankle is important.

Also remember you get compression injuries of the posterior component (tibiotalar) , nothing much happens to the middle component (tibiocalcaneal) unless there is eversion stress , which is unusual, and you get stripping / degloving injuries of the more anterior (tibiospring) component where it is stripped off of the tibia medial malleolus.

Steve

[Author]

Posts