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 Tendon Transfer — Michigan Podiatrist 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.
Medically Reviewed | Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle, Michigan
What Is Tendon Transfer Surgery?
Tendon transfer surgery is a reconstructive procedure where a functioning tendon is detached from its original insertion and reattached to a new location to restore lost motor function, rebalance muscular forces across a joint, or correct a structural deformity. The biological principle: tendons can be rerouted to perform new functions — and with post-operative rehabilitation, the nervous system can learn to activate the transferred tendon in its new role. Successful tendon transfer requires that the donor tendon is strong enough (typically MRC grade 4 or 5) to perform its new function, expendable at its original site (other muscles can compensate), and sufficiently long to reach the new attachment site without excessive tension.
In the foot and ankle, tendon transfers address a range of problems: neuromuscular imbalances from conditions like Charcot-Marie-Tooth disease and stroke-related drop foot, structural deformities like hammertoes and claw toes driven by flexor-extensor tendon imbalance, and reconstructive needs after tendon rupture. Dr. Biernacki performs tendon transfer procedures as part of comprehensive foot deformity correction, often combining tendon transfer with osseous (bone) procedures for complete structural restoration.
Flexor-to-Extensor Tendon Transfer for Hammertoe
The Girdlestone-Taylor flexor-to-extensor tendon transfer (FTFT) is the most common tendon transfer procedure in podiatric surgery — addressing the fundamental muscular imbalance driving hammertoe and claw toe deformity. In a hammertoe, the intrinsic foot muscles are insufficient to counteract the pull of the extrinsic flexors (FDL), causing progressive toe buckling. The FTFT corrects this by releasing the FDL from its plantar insertion on the distal phalanx and rerouting the two slips of the divided tendon dorsally around each side of the proximal phalanx to attach to the extensor hood — converting the deforming flexion force into a corrective extension force. The procedure restores the toe to a straight position and provides active extension strength. Typically performed in combination with proximal interphalangeal (PIP) joint arthroplasty or fusion for complete hammertoe correction.
Tibialis Posterior Transfer for Drop Foot
Foot drop — the inability to lift the foot and toes due to loss of anterior compartment muscle function (tibialis anterior, extensor digitorum, extensor hallucis longus) — is corrected with tibialis posterior transfer through the interosseous membrane. The tibialis posterior tendon is detached from the navicular, passed through a window in the interosseous membrane between the tibia and fibula, and attached to the dorsal midfoot or toe extensors — converting a plantar flexion force into dorsiflexion. The Bridle procedure adds peroneus longus to stabilize the transfer. Post-operative rehabilitation is extensive: 6–8 weeks in boot or cast while the tendon heals in its new position, followed by 3–6 months of retraining the nervous system to activate the transferred muscle in its new role.
Dr. Tom's Product Recommendations
Darco Body Armor Short Walker Boot
⭐ Highly Rated
Protected walking boot for tendon transfer post-operative recovery — maintains foot and toe in corrected alignment while transferred tendons heal in their new positions during the critical early recovery period.
Dr. Tom says: “My podiatrist prescribed the walking boot after my tendon transfer surgery — it kept my toe in the corrected position while I healed.”
Post-tendon transfer protected recovery, hammertoe surgical boot, toe position maintenance
Patients cleared for regular footwear — boot is only for the protected early recovery phase
Disclosure: We earn a commission at no extra cost to you.
TheraBand Resistance Bands (Set of 5)
⭐ Highly Rated
Progressive resistance bands for post-tendon transfer rehabilitation — used in physical therapy to retrain the transferred tendon’s new function through gentle progressive resistance once the tendon is healed.
Dr. Tom says: “My physical therapist used the TheraBands to retrain my tendon transfer — starting with very light resistance and progressing gradually over months.”
Post-tendon transfer rehabilitation, progressive tendon retraining, physical therapy exercise
Early post-operative phase — resistance training begins only after tendon healing is confirmed (typically 6-8 weeks post-op)
Disclosure: We earn a commission at no extra cost to you.
AFO Drop Foot Brace (Ankle-Foot Orthosis)
⭐ Highly Rated
Ankle-foot orthosis for managing drop foot while awaiting tendon transfer surgery or during early post-operative recovery — holds the foot in a functional position to prevent foot slap and tripping during ambulation.
Dr. Tom says: “My podiatrist prescribed the AFO brace for my drop foot while we planned my tendon transfer — it allowed me to walk safely and prevented falls.”
Drop foot management, pre-surgical foot drop support, early post-operative ambulation safety
Post-tendon transfer patients once the transfer is functioning — the brace is discontinued as transferred tendon function develops
Disclosure: We earn a commission at no extra cost to you.
✅ Pros / Benefits
- Flexor-to-extensor tendon transfer (FTFT) provides reliable, permanent hammertoe and claw toe correction
- Tibialis posterior transfer restores meaningful dorsiflexion function in drop foot patients
- Tendon transfers address the underlying muscular imbalance — not just the structural deformity
- Combined osseous and soft tissue procedures achieve comprehensive correction in complex deformities
❌ Cons / Risks
- Tendon transfer requires 6–8 weeks of protected recovery while tendon heals in new position
- Drop foot transfer rehabilitation is a 6–12 month process of tendon retraining — results take time
- Transferred tendon must be MRC grade 4–5 strength at the donor site — weak or paralyzed tendons cannot be transferred
- Tendon transfers are permanent — careful pre-operative planning is essential as revision is complex
Dr. Tom Biernacki’s Recommendation
Tendon transfer surgery is elegant reconstructive work — you’re taking a tendon that’s causing a problem in one location and making it the solution in another. The FTFT for hammertoe is satisfying surgery: the biomechanical logic is clear, the execution is precise, and when it works, the toe is straight and functional. Drop foot tendon transfer is more complex — the rehabilitation is long, and the patient has to relearn how to activate the transferred muscle. But for the right patient with the right surgical plan, the functional improvement is significant. That’s what makes this work rewarding.
— Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle
Frequently Asked Questions
What is a flexor to extensor tendon transfer for hammertoe?
The Girdlestone-Taylor flexor-to-extensor tendon transfer (FTFT) releases the flexor digitorum longus tendon from its plantar attachment and reroutes it dorsally around the proximal phalanx to attach to the extensor hood — converting the deforming downward pull of the flexor into an upward corrective force. The procedure directly addresses the tendon imbalance causing the hammertoe deformity and is typically combined with PIP joint arthroplasty or fusion for complete correction.
How long is recovery from tendon transfer surgery?
Tendon transfer recovery varies by procedure and location. Hammertoe FTFT: 3–4 weeks in post-surgical shoe, return to regular footwear at 6–8 weeks, full activity at 3–4 months. Drop foot tibialis posterior transfer: 6–8 weeks in boot or cast, 3–6 months of physical therapy for tendon retraining, 9–12 months for full functional recovery. Dr. Biernacki provides a detailed recovery timeline at the surgical consultation.
Who is a candidate for tendon transfer surgery?
Candidates for tendon transfer surgery include patients with flexible hammertoe or claw toe deformity where FTFT can correct the imbalance without osseous resection; patients with neuromuscular foot deformities (Charcot-Marie-Tooth, stroke drop foot) where tendon rebalancing restores functional gait; and patients with tendon rupture where transfer of an adjacent tendon restores lost function. All donor tendons must have sufficient strength for their new role.
Is tendon transfer surgery painful?
Post-operative pain from tendon transfer is managed with regional anesthetic blocks placed intraoperatively that provide 12–24 hours of post-operative pain control, followed by oral analgesics as needed. Most patients find tendon transfer recovery manageable with appropriate pain management. The protected boot or cast during early recovery prevents movement that would stress the healing tendon attachment.
Michigan Foot Pain? See Dr. Biernacki In Person
4.9★ rated | 1,123 Reviews | 3,000+ Surgeries
Same-week appointments · Howell & Bloomfield Township
📞 (810) 206-1402 Book Online →What does treatment cost?
Most diagnostic visits and conservative treatments are covered by Medicare and major insurers. Out-of-pocket costs vary by your specific plan.
How quickly can I get an appointment?
Most non-urgent cases see us within 5 business days. Urgent cases (sudden pain, possible fracture) typically same or next business day.
In-Office Treatment at Balance Foot & Ankle
If home treatment isn’t providing relief for your foot issues, our podiatry team at Balance Foot & Ankle can help with same-day evaluations and advanced in-office care.
Related Conditions
American Podiatric Medical Association: Find a Podiatrist
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.