Medically reviewed by Dr. Tom Biernacki, DPM
Board-certified podiatric surgeon | Balance Foot & Ankle, Howell & Bloomfield Township, MI
Last reviewed: May 2026
Quick answer: Tendon Transfer Foot is a common foot/ankle topic that affects many patients. The 2026 evidence-based approach combines proper diagnosis, conservative-first treatment, and escalation only when needed. We treat this regularly at our Howell and Bloomfield Township practices. Call (810) 206-1402.
The most important clinical decision with Tendon Transfer Foot isn’t which treatment to start with — it’s identifying the correct subtype. That changes everything. Call (810) 206-1402.
When Tendon Transfers Are Needed
Tendon transfer surgery is indicated when a muscle-tendon unit is permanently paralyzed or irreversibly damaged, and a nearby functioning tendon can be redirected to restore lost function without creating unacceptable deficit in its donor role.
Foot drop from peroneal nerve palsy: the posterior tibial tendon is transferred anteriorly through the interosseous membrane to the dorsum of the foot, restoring dorsiflexion that the paralyzed anterior compartment muscles (tibialis anterior, extensor digitorum longus) can no longer provide. This is the most common foot tendon transfer.
Claw toe correction: the flexor digitorum longus tendon is split and rerouted to the dorsum of the proximal phalanx (Girdlestone-Taylor transfer), converting the flexor’s deforming plantar pull into an extensor corrective force.
Achilles tendon reconstruction: when the Achilles tendon is irreparably damaged, the flexor hallucis longus (FHL) tendon is transferred to the calcaneus as a neo-Achilles, restoring plantarflexion strength.
What to Expect from Tendon Transfer Surgery
The donor tendon must be expendable: before using a tendon for transfer, the surgeon confirms that its loss will not create significant dysfunction. The FHL is an ideal donor for Achilles reconstruction because the flexor digitorum longus compensates for its loss in most activities.
Tendon transfers work best when the passive range of motion at the target joint is preserved: a stiff joint that won’t move even when the tendon pulls correctly will not benefit from transfer. Joint mobilization or release often accompanies tendon transfer.
Recovery includes an initial cast period (4–6 weeks) for healing of the tendon attachment to bone, followed by protected weight bearing, then intensive physical therapy to teach the brain to activate the transferred tendon in its new role. This neurological re-education is as important as the surgery itself — it takes 3–6 months of dedicated therapy.
Results and Expectations
Foot drop correction with posterior tibial tendon transfer: most patients achieve community ambulatory ability without a foot drop brace. Some degree of drop foot brace use may still be needed for high-demand activities. The transfer provides active dorsiflexion, not normal strength.
Achilles reconstruction with FHL transfer: 85–90% of patients achieve satisfactory plantarflexion strength for walking and stair climbing. Return to running is less predictable — some patients achieve it, others find the FHL doesn’t generate sufficient power.
Claw toe correction: high success rates for deformity correction, though recurrence (50% over 10 years) is a known limitation — particularly in neurological conditions with progressive muscle imbalance.
Dr. Tom's Product Recommendations
PowerStep Pinnacle Insoles
⭐ Highly Rated
Supportive insoles for post-tendon transfer rehabilitation and long-term foot function
Dr. Tom says: “After tendon transfer surgery, proper arch support in the transition back to normal footwear supports the reorganized musculotendinous function and reduces compensatory arch strain.”
Post-tendon transfer rehabilitation, return to footwear phase, ongoing support
Immediate post-surgical period in cast or boot
Disclosure: We earn a commission at no extra cost to you.
DASS Medical Compression Socks
⭐ Highly Rated
Post-surgical compression for tendon transfer edema management
Dr. Tom says: “Major tendon transfer procedures cause significant ankle and foot swelling during recovery. DASS compression reduces edema once cleared by Dr. Biernacki.”
Post-tendon transfer swelling, rehabilitation phase compression
Pre-clearance from Dr. Biernacki
Disclosure: We earn a commission at no extra cost to you.
✅ Pros / Benefits
- Posterior tibial tendon transfer for foot drop dramatically improves ambulatory function
- FHL-to-calcaneus transfer for Achilles reconstruction provides reliable plantarflexion
- Girdlestone-Taylor transfer for claw toes achieves high correction rates
❌ Cons / Risks
- All tendon transfers require extensive rehabilitation for neurological re-education
- Results rarely achieve normal function — improved but not pre-injury performance
- Claw toe transfer recurrence rates of 50% over 10 years in neurological conditions
Dr. Tom Biernacki’s Recommendation
Tendon transfer surgery is one of the most technically complex and most rewarding procedures in foot and ankle surgery. When a patient with foot drop from peroneal nerve injury walks out of physical therapy 6 months after a posterior tibial tendon transfer without an AFO brace — that’s a life-changing outcome. The key is patient selection: the right transfer for the right diagnosis, in a patient who will commit to the months of post-operative therapy that makes the surgery work.
— Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle
Frequently Asked Questions
How long does tendon transfer surgery take?
1–3 hours depending on complexity and whether concurrent procedures are performed.
How long is recovery from foot tendon transfer?
6–12 months for full rehabilitation — 4–6 weeks in cast, 2–3 months protected walking, 3–6 months of intensive physical therapy.
Does tendon transfer hurt?
The procedure is performed under anesthesia. Recovery pain is managed with regional block and medications. Physical therapy during neurological re-education can be demanding.
Can tendon transfer cure foot drop?
It significantly improves function — most patients achieve usable dorsiflexion for walking. Return to running or high-demand sport is less consistent.
When Shoes Aren’t Enough — Dr. Tom’s Top 9 Orthotics
About 30% of patients I see for foot pain need MORE than a great shoe — they need a structured insole. Below: my complete 2026 orthotic ranking with pros, cons, and the specific patient I’d give each one to.
⚕ Doctor Recommended
Doctor Hoy’s Natural Pain ReliefTopical relief for foot & ankle pain
View Product →AAOS OrthoInfo: Tendon Transfer Surgery of the Foot
Ready to Get Relief?
Same-day appointments available in Howell & Bloomfield Township, MI
4.9★ | 1,123 Reviews | 3,000+ Surgeries
Or call: (810) 206-1402
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.