Medically reviewed by Dr. Tom Biernacki, DPM
Board-certified podiatric surgeon | Balance Foot & Ankle, Howell & Bloomfield Township, MI
Last reviewed: May 2026
Most patients underestimate how much the post-operative phase determines Foot Tendon Transfer : Indications, Techniques, and outcomes — not the surgery itself. Our podiatric surgeons identify the single recovery variable that separates patients who return to full activity on schedule from those who experience setbacks. Call (810) 206-1402 — expert podiatric care across Michigan.
Tendon transfer surgery reroutes a functioning muscle-tendon unit to restore movement lost due to nerve injury, tendon rupture, or neuromuscular disease. In the foot and ankle, transfers address foot drop, hallux claw deformity, peroneal dysfunction, and posterior tibial tendon failure — restoring active motor function that bracing alone cannot replace.
Common Foot Tendon Transfers and Their Indications
| Transfer | Donor Tendon | Recipient Site | Primary Indication |
|---|---|---|---|
| Posterior tibial to dorsum (SPLATT/full transfer) | Posterior tibial tendon | Dorsal midfoot or split to peroneus brevis | Foot drop from peroneal palsy; spastic equinovarus |
| Peroneus longus to brevis | Peroneus longus | Peroneus brevis insertion | Peroneus brevis tear with intact longus; cavus foot |
| FHL to FHB/sesamoid (Jones transfer) | Flexor hallucis longus | Flexor hallucis brevis / base of proximal phalanx | Hallux claw; intrinsic minus hallux; Charcot-Marie-Tooth |
| EHL to first metatarsal neck (Robert Jones) | Extensor hallucis longus | First metatarsal neck | Cock-up hallux deformity; cavus correction |
| FDL to navicular (Cobb/Hintermann) | Flexor digitorum longus | Navicular | Stage II adult-acquired flatfoot; PTT dysfunction |
Tendon Transfer Principles and Recovery Phases
| Principle | Clinical Implication | Recovery Phase | Timeline |
|---|---|---|---|
| One grade strength loss | Donor must be grade 4-5 preoperatively; transfers grade down one level | Non-weight-bearing immobilization | 0-6 weeks |
| Straight-line pull | Transfer routed in direct line to insertion for maximum mechanical efficiency | Partial weight-bearing, PT begins | 6-10 weeks |
| Tension setting | Tendon fixed at slightly higher tension than desired; tension reduces with remodeling | Progressive strengthening | 10-16 weeks |
| Re-education required | Brain must learn new function for transferred muscle; takes 3-6 months | Functional retraining | 4-9 months |
Tendon transfers work best when the target joint is supple (no fixed contracture), the donor muscle retains adequate strength (grade 4+), and the patient is motivated for rehabilitation. Fixed deformities require simultaneous bony correction (osteotomy or arthrodesis) before or with the transfer.
At Balance Foot & Ankle in Howell and Bloomfield Township, we evaluate tendon transfer candidacy with gait analysis, muscle strength testing, and imaging. Call (810) 206-1402.
American Academy of Orthopaedic Surgeons: Foot Tendon Transfer
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Doctor Answer
What types of foot tendon transfers are performed and why?
Foot tendon transfers reroute functioning tendons to replace the action of paralyzed or irreparably damaged ones. Common transfers include posterior tibial to dorsum for drop foot, flexor digitorum longus to navicular for flatfoot reconstruction, peroneus longus to brevis for peroneal tendon deficiency, and flexor tendon transfers for claw toe correction. I match the transferred tendon’s excursion and strength to the required function. Intensive retraining is essential — the brain must learn to activate the tendon in its new role.
Dr. Tom Biernacki, DPM is a board-certified foot & ankle surgeon (ABFAS & ABPM) at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has made him one of the most-followed foot & ankle educators on YouTube.