Technical tips: Reconstruction of deep and superficial deltoid ligaments by peroneus longus tendon in stage 4 posterior tibial tendon dysfunction

Highlights • Correcting valgus tilt at the time of flatfoot reconstruction in case of stage 4 posterior tibial tendon dysfunction may prevent future collapse and the need for ankle arthrodesis or possibly ankle arthroplasty. • In order to restore both the eversion and external rotation stability of the ankle, both the superficial and deep deltoid ligaments need to be reconstructed. • In this reported technique, the tibiospring, tibiocalcaneal and deep tibiotalar ligaments are reconstructed. • The superficial and deep deltoid construct is incorporated with the first metatarsal by the peroneus longus tendon.