Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.
Medically Reviewed by Dr. Jeffery Agnoli, DPM — Board-Certified Podiatrist, Balance Foot & Ankle Specialists, Michigan. Last updated April 2026.
Foot drop — the inability to dorsiflex the ankle, producing a high-stepping gait or dropped toe during swing phase — results from peroneal nerve palsy, L4–5 radiculopathy, Charcot-Marie-Tooth disease, or stroke, and produces significant functional impairment and fall risk. When the underlying neurological cause cannot be reversed and ankle-foot orthosis (AFO) use is not satisfactory, tibialis posterior tendon transfer provides a dynamic surgical solution that restores functional ankle dorsiflexion without external bracing.
Patient Selection and Surgical Technique
Patient selection for tendon transfer: persistent foot drop with a functional tibialis posterior muscle (the muscle must have at least grade 4/5 strength to power the transfer through its new mechanical position); adequate passive dorsiflexion (the ankle must be able to reach neutral passively — if equinus is fixed, Achilles lengthening must be combined with the transfer); patient motivation for rehabilitation (the transfer requires intensive physical therapy to train the brain to fire the transferred muscle in its new role). Technique: the tibialis posterior tendon is mobilized from its navicular attachment through a medial ankle incision, re-routed anteriorly through the interosseous membrane of the lower leg, and anchored to the dorsal foot structures (cuneiform, metatarsal bases, or extensor tendons) using a bone anchor or interference screw. The result: the tibialis posterior — which normally inverts and plantarflexes the foot — fires anteriorly to dorsiflex the foot during swing phase, eliminating foot drop. Recovery: non-weight-bearing for 6 weeks; intensive gait retraining with physical therapy for 3–6 months to teach the new movement pattern; full functional restoration at 9–12 months. Outcomes: 80–90% of patients achieve a functional outcome (active dorsiflexion, no foot drop during gait); some patients still require a light AFO for longer distances. Dr. Biernacki at Balance Foot & Ankle evaluates tendon transfer candidacy for foot drop in patients with peroneal palsy and CMT disease. Call (810) 206-1402 at our Bloomfield Hills or Howell office for consultation.
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Our board-certified podiatrists treat this condition at two convenient locations. Same-day appointments often available.
Frequently Asked Questions
When should I see a podiatrist?
See a podiatrist for any foot or ankle pain that persists more than 2 weeks, doesn’t improve with rest, limits your daily activities, or is accompanied by swelling, numbness, or skin changes. People with diabetes or circulation problems should see a podiatrist regularly even without symptoms.
What does a podiatrist treat?
Podiatrists diagnose and treat all conditions of the foot, ankle, and lower leg including plantar fasciitis, bunions, hammertoes, toenail problems, heel pain, nerve pain, diabetic foot care, sports injuries, fractures, and foot deformities — both surgically and non-surgically.
What can I expect at my first podiatry visit?
Your first visit includes a full medical history, physical examination of your feet and gait, and in-office diagnostic imaging if needed (X-rays, ultrasound). We’ll discuss your diagnosis and create a personalized treatment plan. Most visits take 30–45 minutes.
Need Treatment at Balance Foot & Ankle?
Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients at our Howell and Bloomfield Township offices.
Book Online or call (810) 206-1402
Foot Drop Treatment & Tendon Transfer Surgery in Michigan
Foot drop from nerve damage causes tripping and difficulty walking. Our podiatric surgeons perform tendon transfer procedures to restore ankle dorsiflexion and eliminate the need for bracing, giving patients back their natural walking ability.
Explore Our Surgical Options | Book Your Appointment | Call (810) 206-1402
Clinical References
- Vigasio A, Marcoccio I, Patelli A, et al. New tendon transfer for correction of drop-foot in common peroneal nerve palsy. Clin Orthop Relat Res. 2008;466(6):1454-1466.
- Rodriguez RP. The Bridle procedure in the treatment of paralysis of the foot. Foot Ankle. 1992;13(2):63-69.
- Hove LM, Nilsen PT. Posterior tibial tendon transfer for drop-foot. Foot Ankle Int. 1998;19(8):535-537.
Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon 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 reached over one million views.
- Plantar Fasciitis: Diagnosis and Conservative Management (PubMed)
- Plantar Fasciitis (APMA)
- Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
- Heel Pain (APMA)