When should I see a podiatrist?

You should see a podiatrist for any persistent foot or ankle pain lasting more than a few days, difficulty walking, numbness or tingling, wounds that won't heal, changes in skin color or temperature, or structural deformities. Dr. Tom Biernacki, DPM is a board-certified podiatrist serving SE Michigan with same-day appointments available. Call 810-206-1402.

Does Dr. Biernacki accept insurance?

Balance Foot & Ankle accepts most major insurance plans including Blue Cross Blue Shield, Aetna, United Healthcare, Cigna, Medicare, and many others. Contact our office at 810-206-1402 to verify your specific coverage. We also offer affordable self-pay options.

What should I expect at my first podiatry appointment?

Your first visit includes a comprehensive evaluation with Dr. Biernacki including medical history review, physical examination, biomechanical assessment, and any necessary diagnostic imaging (X-rays are available in-office). You'll receive a diagnosis, treatment plan, and same-day treatment when possible. Most initial visits take approximately 30-45 minutes.

What is a tendon transfer in the foot?

A tendon transfer moves a functioning tendon from its normal insertion to a new location to replace the action of a damaged or non-functioning tendon. For example, in PTTD, the flexor digitorum longus tendon is transferred to take over the arch-supporting role of the failed posterior tibial tendon. The donor tendon maintains its nerve supply and muscle power.

When are tendon transfers needed in the foot?

Common indications include foot drop (transferring the posterior tibial tendon to the dorsum of the foot), PTTD Stage II (FDL tendon transfer to support the arch), hammertoe correction (flexor-to-extensor transfer), Achilles tendon deficiency (FHL transfer), and cavovarus foot correction (peroneus longus to peroneus brevis transfer). The goal is to restore balanced muscle forces.

How long is recovery from tendon transfer surgery?

Recovery involves 4-6 weeks of non-weight-bearing or protected weight-bearing to allow the transferred tendon to heal in its new position, followed by 4-6 weeks in a walking boot, then physical therapy to retrain the brain to use the transferred muscle for its new function. Full recovery and optimal function take 6-12 months. Rehabilitation is critical for a good outcome.

Tendon Transfers in Foot and Ankle Surgery: When and Why

Name: Tendon Transfers in Foot and Ankle Surgery: When and Why
Creator: Dr. Tom Biernacki, DPM
Published: 2026-03-23T13:18:11-04:00

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.

Learn About Our Surgical Treatment Options | Book Your Appointment | Call (810) 206-1402

Clinical References

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.
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.
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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Howell Office

3980 E Grand River Ave, Suite 140

Howell, MI 48843

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Bloomfield Hills Office

43700 Woodward Ave, Suite 207

Bloomfield Hills, MI 48302

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Your Board-Certified Podiatrists

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.