Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

Tendon transfer surgery — in which a functioning tendon is rerouted from its original attachment point to a new insertion to compensate for the loss of a paralyzed or absent muscle — is an important but underappreciated reconstructive tool in foot and ankle surgery. It addresses the root cause of foot deformities that result from muscle imbalance: when one muscle group is absent or weakened (from neurological injury, trauma, or congenital condition), the antagonist pulls unchecked, causing progressive deformity. At Balance Foot & Ankle in Southeast Michigan, Dr. Tom Biernacki performs tendon transfer procedures in the context of comprehensive foot and ankle reconstruction.

Common Tendon Transfer Procedures

Posterior tibial tendon (PTT) transfer for drop foot: in patients with drop foot (weakness of dorsiflexion from peroneal nerve injury or CMT disease), the posterior tibial tendon is rerouted through the interosseous membrane from the medial to the anterior compartment and attached to the dorsum of the foot — converting a plantarflexor/invertor into a dorsiflexor. This restores active clearance of the foot during gait, eliminating the need for an AFO in appropriate patients. FHL (flexor hallucis longus) transfer for Achilles insufficiency: used in insertional Achilles pathology with tendon degeneration or for late-presenting ruptures with tendon deficit. The FHL passes behind the medial malleolus to the posterior calcaneus — its power and direction closely mimic the Achilles. Most patients have minimal FHL loss as the FHL flexion arc is replaced by FDL. PTT transfer for lateral instability: used in neurological conditions (CMT, post-polio) where chronic inversion deformity has caused recurrent lateral ankle sprains uncontrollable with bracing. Flexor-to-extensor tendon transfer for hammertoe: the FDL (long flexor) of an affected toe is divided and rerouted over the top of the toe to the extensor apparatus — corrects a flexible hammertoe by converting the deforming force into a correcting force (Girdlestone-Taylor transfer).

Patient Selection and Outcomes

Tendon transfer success depends critically on: the donor tendon having sufficient excursion and strength (typically grade 4–5 MRC) to perform its new function; the deformity being correctable or corrected simultaneously (a tendon transfer into a rigid deformity doesn’t work); the absence of significant spasticity (spastic muscles don’t respond predictably to transfer); and appropriate rehabilitation to teach the patient the new motor pattern (the brain must re-learn to activate a muscle in its new role). Most tendon transfers in appropriately selected patients produce excellent, durable results — but the rehabilitation phase of learning to use the transferred tendon in its new role is essential and takes 6–12 months.

Frequently Asked Questions

Complex foot deformity from muscle imbalance or nerve injury may benefit from tendon transfer. Contact Balance Foot & Ankle in Southeast Michigan for comprehensive evaluation with Dr. Biernacki.

Expert Foot & Ankle Surgery in Michigan

Tendon transfer surgery restores function when tendons are damaged beyond repair. Our podiatric surgeons perform advanced tendon transfers with proven rehabilitation protocols for optimal outcomes.

See Our Surgical Treatment Services → | Book Your Appointment | Call (810) 206-1402

Clinical References

1. Myerson MS, Corrigan J, et al. “Tendon transfer combined with calcaneal osteotomy for treatment of posterior tibial tendon insufficiency.” Foot & Ankle International. 1995;16(11):712-718.
2. Haddad SL, Myerson MS, et al. “Clinical and radiographic outcome of revision surgery for failed first metatarsophalangeal joint surgery.” Foot & Ankle International. 1997;18(1):34-39.
3. Song SJ, DeLeo AT, Schon LC. “Tendon transfer to address insufficiency of the posterior tibial tendon.” Foot and Ankle Clinics. 2003;8(3):459-474.

Your Board-Certified Podiatrists

Dr. Tom Biernacki, DPM

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Dr. Tom Biernacki, DPM

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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.