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 for foot drop?

A tendon transfer reroutes a functioning tendon to replace the function of the paralyzed muscles that lift the foot. The most common procedure transfers the posterior tibial tendon through the interosseous membrane to the top of the foot, allowing it to dorsiflex the ankle. This eliminates the need for a permanent ankle brace in many patients.

Who is a candidate for foot drop tendon transfer?

Candidates include patients with permanent peroneal nerve damage that has not recovered after 12-18 months, patients with foot drop from neurological conditions, those who cannot tolerate ankle bracing, and active individuals who want to walk without external support. The donor tendon (posterior tibial) must have adequate strength, confirmed by clinical testing before surgery.

What is recovery like after tendon transfer surgery?

Recovery involves 6 weeks in a cast with no weight bearing to protect the tendon transfer, followed by 6 weeks in a walking boot with progressive weight bearing, then 3-6 months of physical therapy to retrain the transferred tendon for its new function. Most patients walk without a brace by 4-6 months, though full adaptation takes up to a year.

Tendon Transfers for Foot Drop | What to Expect in Michigan

Name: Tendon Transfers for Foot Drop | What to Expect in Michigan
Creator: Dr. Tom Biernacki, DPM
Published: 2026-03-23T12:03:21-04:00

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 Foot Drop?

Foot drop — the inability to raise the front part of the foot during walking — is a disabling condition resulting from weakness or paralysis of the muscles that dorsiflex (lift) the ankle. The characteristic “steppage gait” — lifting the knee high to clear the foot from the ground — is the hallmark of foot drop and places significant energy demands on the entire lower extremity.

While AFOs (ankle-foot orthoses) provide mechanical assistance, tendon transfer surgery offers the possibility of active, muscle-powered correction without relying on an external brace. At Balance Foot & Ankle in Howell and Bloomfield Township, Michigan, we evaluate foot drop patients to determine appropriate candidacy for surgical correction.

Causes of Foot Drop

Foot drop results from dysfunction anywhere along the neural pathway controlling the tibialis anterior and extensor muscles. Common causes include peroneal nerve palsy from knee or hip surgery, trauma, or prolonged compression; lumbar disc herniation compressing L4-L5 nerve roots; central nervous system conditions (stroke, multiple sclerosis, ALS); Charcot-Marie-Tooth disease; and compartment syndrome aftermath. The prognosis for recovery depends greatly on the cause — some causes are reversible while others result in permanent muscle loss.

When Tendon Transfer Is Considered

Tendon transfer for foot drop is considered when: the neurological injury is permanent or plateau has been reached without recovery, voluntary motor function exists in suitable donor muscles, the ankle joint is flexible (no fixed equinus contracture), and the patient understands the rehabilitation requirements. Surgery is not appropriate when recovery is still possible (premature transfer would eliminate potential for return of natural function) or when severe, fixed deformities require bony correction first.

The Tibialis Posterior Tendon Transfer

The most established tendon transfer for foot drop uses the tibialis posterior tendon — which normally plantarflexes and inverts the foot — rerouted through the interosseous membrane to the dorsal foot, where it can power dorsiflexion. This transforms a deforming force into a corrective one. The procedure requires meticulous surgical technique to route the tendon with appropriate tension and direction to achieve balanced dorsiflexion without excessive inversion or eversion.

Alternative transfers using the peroneus longus or flexor digitorum longus may be employed depending on which muscles are available and the specific pattern of weakness present.

Recovery and Rehabilitation

Recovery from tendon transfer surgery requires extensive rehabilitation that is more demanding than most orthopedic procedures because the brain must learn to use the transferred tendon for a completely new function. Immobilization in a cast for 6-8 weeks allows tendon healing. Subsequent physical therapy involves motor re-education — systematically training the patient to activate the transferred tendon in its new role. This neurological reprogramming process takes 6-18 months and requires dedicated patient effort. Most patients achieve significant functional improvement, with many able to discard or significantly reduce AFO usage.

Realistic Expectations

Tendon transfer for foot drop is not a procedure that restores normal gait overnight — it is a functional reconstruction that requires patient commitment to rehabilitation. The best outcomes occur in motivated patients with appropriate expectations, flexible joints, available donor muscles, and access to experienced physical therapy. A thorough consultation with your podiatric surgeon will clarify whether you are an appropriate candidate and what functional improvement you can realistically anticipate.

Foot or Ankle Pain? We Can Help.

Balance Foot & Ankle — Howell & Bloomfield Township, MI

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Tendon Transfer for Foot Drop? Expert Surgical Restoration

When foot drop does not recover with conservative treatment, tendon transfer surgery can restore the ability to lift your foot during walking. Dr. Tom Biernacki performs tendon transfer procedures that dramatically improve gait and reduce fall risk.

Learn About Surgical Foot Drop Treatment | Book Your Appointment | Call (810) 206-1402

Clinical References

Rodriguez RP. The Bridle procedure in the treatment of paralysis of the foot. Foot and Ankle International. 1992;13(8):462-469.
Hove LM, Nilsen PT. Posterior tibial tendon transfer for drop-foot. Foot and Ankle International. 1998;19(8):535-537.
Johnson JE, Paxton ES. Tendon transfers in the foot and ankle. Current Opinion in Orthopaedics. 2007;18(2):136-140.

Dr. Tom Biernacki, DPM

Affiliate Disclosure: This page contains affiliate links to products we recommend. If you purchase through these links, Balance Foot & Ankle may earn a small commission at no additional cost to you. We only recommend products we use with our patients.

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.