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A 35-year-old man is referred to you for left foot pain after falling from a bicycle. A recent MRI shown in Figure A. The injured structure demonstrated in the MRI will most likely lead to which of the following deformities if left untreated?
Widening of the 1st and 2nd tarsometatarsal joints
Hallux valgus deformity
Talar tilt deformity
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Figure A demonstrates a disrupted calcaneonavicular ligament (Spring ligament). Chronic deficiency of this structure can lead to a flatfoot deformity.
The ability of the medial longitudinal arch to prevent flatfoot deformity depends on the dynamic support of the posterior tibial tendon, the static support of ligaments and capsule (including the Spring ligament), and the manner in which the tarsal bones interlock.
Gadzag retrospectively found that 18 of 22 patients undergoing surgery for flatfoot deformity had varying levels of injury to the spring ligament but their study design prevented them from concluding whether ligament repair was beneficial.
Illustration A contains an MRI of a normal Spring ligament (right) shown with a green arrow compared to a disrupted Spring ligament (left) shown with the red arrow. Illustration B is a cadaveric dissection showing the spring ligament (5) once the posterior tibial tendon (9) has been reflected.
Gazdag AR, Cracchiolo A 3rd.
J Bone Joint Surg Am. 1997 May;79(5):675-81. PMID: 9160939 (Link to Abstract)
Gazdag, JBJS 1997
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HPI - history of twisting injury left ankle 2years back,treated by rest analgesics and crepe bandage.pain has gradually worsened and also sometimes radiates up the leg
What should be mode of treatment plan