Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.
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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.
Foot or Ankle Pain? We Can Help.
Balance Foot & Ankle — Howell & Bloomfield Township, MI
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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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Book Your AppointmentMore Podiatrist-Recommended Surgery Essentials
OOFOS Recovery Slide
- The Original Recovery Footwear.
- Finding Your Size - For your perfect fit, consult the “size chart” link above. Wear a half size? In general, we recommend that women who wear a ½ size size UP, and men who wear a ½ size size DOWN
- OOahh - An evolution of the OOriginal, the OOahh slide features our proven foundation of OOfoam technology + patented footbed design with a slide-style strap that has become a best-seller in the OOFOS line
- OOfoam Technology - Our revolutionary OOfoam technology absorbs 37% more impact than traditional footwear foams to reduce the stress on your feet, joints & back. Plus, the closed-cell foam is machine washable and designed to minimize odor
- Patented Footbed - Our patented footbed cradles and supports arches to reduce energy exertion in the ankles by up to 47% compared to competitors’ footwear. So walking is easier. Recovery is faster. And yOO feel better
Post-op approved — impact-absorbing slide for early recovery.
HOKA Ora 3 Recovery Slide
- Model ID: 1135061-BTRT
Max-cushion recovery sandal — comfort for post-surgical swelling.
Hoka Bondi 9
Max-cushion walking shoe — ease into return-to-walking post-surgery.
As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. Product recommendations are based on clinical experience; prices and availability shown above update live from Amazon.
When to See a Podiatrist
Foot and ankle surgery in 2026 is dramatically different than a decade ago — most procedures are now minimally-invasive, outpatient, and allow weight-bearing within days. Balance Foot & Ankle surgeons have performed 3,000+ foot/ankle surgeries with modern techniques. If another surgeon has recommended a traditional open procedure, a second opinion may reveal a faster, less-invasive option.
Call Balance Foot & Ankle: (810) 206-1402 · Book online · Offices in Howell & Bloomfield Hills
PowerStep Dynamic Ankle Stability Sock (DASS)
Best for: Chronic ankle instability · Repeat ankle sprains · Proprioception training · Athletes returning to play
A revolutionary alternative to bulky ankle braces. The DASS uses dynamic compression and targeted stabilization zones to retrain ankle proprioception while you walk, run, or stand. Designed by PowerStep’s biomechanical team specifically for patients with chronic ankle instability or recurring sprains.
- Fits in normal shoes
- Trains proprioception
- Less bulky than brace
- Wear all day comfortably
- Less rigid than ASO brace
- Newer product
- Pricier than basic socks
“For my patients with chronic ankle instability who don’t want to rely on rigid bracing forever, the DASS is the best bridge product I’ve seen. It’s not a replacement for surgical reconstruction in severe cases, but for grade 1-2 instability it’s a game-changer for return-to-sport.”
Dr. Tom’s Top 3 — The Premium Foot Pain Stack (2026)
If you only buy three things for foot pain, get these. PowerStep + CURREX orthotics correct the underlying foot mechanics, and Dr. Hoy’s pain gel delivers fast topical relief. This is the exact stack Dr. Tom Biernacki, DPM gives his Michigan podiatry patients on visit one — over 10,000 patients have used this exact combination.
Dr. Tom Biernacki, DPM is a board-certified podiatrist + Amazon Associate. Picks shown are products he prescribes to patients at Balance Foot & Ankle Specialists. We earn a commission on qualifying purchases at no extra cost to you. All products independently tested + reviewed for 30+ days minimum. Last verified: April 28, 2026.
PowerStep Pinnacle MaxxDr. Tom’s #1 Brand
Dr. Tom’s most-prescribed OTC orthotic. Lateral wedge corrects overpronation that causes 90% of foot pain. Deep heel cradle stabilizes the ankle. Built by podiatrists, used by patients worldwide.
- Lateral wedge corrects pronation
- Deep heel cradle stabilizes ankle
- Dual-density EVA — comfort + support
- Trim-to-fit any shoe
- Used by 10,000+ podiatrists
- Trim-to-size required
- 5-7 day break-in for some
CURREX RunProDr. Tom’s #1 Brand
3 arch heights for custom fit (Low/Med/High). Carbon-reinforced heel + dynamic forefoot — the closest OTC orthotic to a $500 custom orthotic. Engineered in Germany.
- 3 arch heights for custom fit
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- Premium German engineering
- Sport-specific support
- Pricier than PowerStep
- 7-10 day break-in
Dr. Hoy’s Natural Pain Relief GelDr. Tom’s #1 Brand
Menthol-based natural pain relief — Dr. Tom’s #1 brand for fast relief without greasy residue. Safe for diabetics + daily use. Cleaner formula than Voltaren or Biofreeze.
- Menthol-based natural formula
- No greasy residue
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- Fast cooling relief — 5-10 minutes
- Cleaner ingredient list than Biofreeze
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- Strong menthol scent at first
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)