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Tendon Transfers in Foot and Ankle Surgery: When and Why

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. Tom Biernacki, DPM — Board-Certified Podiatrist, Balance Foot & Ankle Specialists, Michigan. Last updated April 2026.

What Is a Tendon Transfer?

A tendon transfer is a surgical procedure in which a functioning tendon (and its attached muscle) is detached from its normal insertion and reattached to a different location to compensate for the loss of a tendon or muscle that can no longer perform its function. Tendon transfers are among the most elegant procedures in foot and ankle surgery — using the body’s own resources to restore function lost to neurological damage, tendon rupture, or deformity.

Foot Drop: The Most Common Indication

When the anterior compartment muscles that dorsiflex the foot are permanently denervated (from peroneal nerve injury, lumbar spine pathology, or Charcot-Marie-Tooth disease), the foot drops and drags during the swing phase of gait. Tendon transfer redirects the posterior tibial tendon — which normally plantarflexes and inverts the foot — through the interosseous membrane to the dorsum of the foot, providing active dorsiflexion. This tendon transfer procedure converts an inverter to a dorsiflexor, dramatically improving gait without requiring lifelong AFO bracing in selected patients.

Posterior Tibial Tendon Dysfunction

In Stage 2 PTTD where the posterior tibial tendon has degenerated beyond repair but the flatfoot deformity remains flexible, the flexor digitorum longus (FDL) tendon is transferred to the navicular to substitute for the failed posterior tibial tendon. This FDL transfer, combined with calcaneal osteotomy and spring ligament repair, is the cornerstone of Stage 2 PTTD reconstruction — restoring both the tendon function and the bony alignment contributing to deformity.

Peroneal Tendon Substitution

When the peroneus brevis tendon (which everts the foot and stabilizes the ankle laterally) is irreparably torn, the peroneus longus can be transferred to serve as a brevis substitute, restoring lateral ankle stability in patients with both peroneal tendinopathy and chronic instability.

Principles of Tendon Transfer Selection

Successful tendon transfers require: a donor tendon with adequate strength (at least grade 4/5 muscle power), appropriate excursion and vector for the new function, a reasonably supple joint at the destination (contracture must be addressed separately), and the absence of active infection. The transferred tendon works best if it performs a function similar to its original action (agonist transfer) — the re-education process for antagonist transfers is longer. Recovery from tendon transfer surgery includes a period of non-weight-bearing followed by guided physical therapy for tendon re-education and strength building.

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When to See a Podiatrist About Tendon Transfer Surgery

Tendon transfer surgery reroutes a working tendon to replace the function of a damaged or paralyzed tendon. At Balance Foot & Ankle, Dr. Tom Biernacki performs tendon transfers for foot drop, PTTD, hammertoes, and other conditions where muscle imbalance causes progressive deformity.

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Clinical References

  1. Hintermann B, Valderrabano V, Nigg B. Influence of screw type on obtained contact area and contact force in a cadaveric subtalar arthrodesis model. Foot Ankle Int. 2002;23(11):986-991.
  2. Mizel MS, Temple HT, Scranton PE Jr, et al. Role of the peroneal tendons in the production of the deformed foot with posterior tibial tendon deficiency. Foot Ankle Int. 1999;20(5):285-289.
  3. Myerson MS. Adult acquired flatfoot deformity: treatment of dysfunction of the posterior tibial tendon. Instr Course Lect. 1997;46:393-405.

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Medical References
  1. Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
  2. Heel Pain (APMA)
  3. Hallux Valgus (Bunions): Evaluation and Management (PubMed)
  4. Bunions (Mayo Clinic)
This article has been reviewed for medical accuracy by Dr. Tom Biernacki, DPM. References are provided for informational purposes.
Balance Foot & Ankle surgeons are affiliated with Trinity Health Michigan, Corewell Health, and Henry Ford Health — three of Michigan’s largest health systems.