Medically reviewed by Dr. Tom Biernacki, DPM
Board-certified podiatric surgeon | Balance Foot & Ankle, Howell & Bloomfield Township, MI
Last reviewed: May 2026
Tibial tendon transfer reroutes a functional posterior or anterior tibial tendon to restore lost dorsiflexion or correct foot deformity — and the specific nerve injury pattern and muscle strength grading are the factors that determine which tendon can be safely transferred without creating a new deficit. Call (810) 206-1402 — expert podiatric care across Michigan.
Tibial tendon transfer is a reconstructive procedure that redirects the pull of a functioning tendon to compensate for loss of another — most commonly to address foot drop (anterior tibial tendon paralysis), equinovarus deformity, or advanced flatfoot (posterior tibial tendon dysfunction stage III-IV). Unlike tendon repair, transfer reroutes a healthy tendon to restore a lost function permanently.
Common Tibial Tendon Transfer Procedures
| Procedure | Tendon Transferred | Target Function Restored | Primary Indication |
|---|---|---|---|
| Posterior tibial tendon transfer (PTTT) for foot drop | Posterior tibial tendon → dorsum of foot | Ankle dorsiflexion; eliminates steppage gait | Peroneal nerve palsy; CMT disease; foot drop from L4-L5 radiculopathy (selected) |
| Tibialis anterior rerouting | Tibialis anterior → lateral cuneiform or cuboid | Corrects dynamic supination in equinovarus | Spastic equinovarus (stroke, CP); CMT with supination deformity |
| FDL to navicular transfer (flatfoot) | Flexor digitorum longus → navicular | Medial arch support; replaces failed PTT function | Stage II-III PTTD; PTT rupture non-responsive to bracing |
| Peroneus longus to brevis transfer | Peroneus longus → peroneus brevis stump | Lateral ankle stability; eversion power | Peroneus brevis complete rupture; irreparable brevis tear |
Tibial Tendon Transfer Recovery Phases
| Phase | Timeframe | Status | Key Goals |
|---|---|---|---|
| Immobilization | Week 0-6 | Non-weight bearing; short leg cast in corrected position | Tendon-to-bone or tendon-to-tendon healing; no tension on repair |
| Protected mobilization | Week 6-10 | Cam boot; partial then full WB; begin supervised ROM | Gentle active motion; prevent adhesions; neuromuscular re-education |
| Retraining | Week 10-20 | Shoe + AFO; intensive PT | Transfer muscle re-education (new movement pattern); strength building |
| Functional integration | Month 5-9 | Increasing independence from AFO | Gait normalization; balance; return to activity; possible AFO weaning |
| Long-term outcome | 12-18 months | Final functional result | Most patients achieve improved gait pattern; full independence varies by diagnosis |
At Balance Foot & Ankle in Howell and Bloomfield Township, we evaluate complex foot and ankle deformities requiring tendon reconstruction and coordinate care with neurology and physical therapy for optimal outcomes. Call (810) 206-1402.
American Academy of Orthopaedic Surgeons: Foot Drop Treatment
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Doctor Answer
What is a tibial tendon transfer and when is it used?
Tibial tendon transfer — most commonly posterior tibial tendon to the dorsum of the foot — restores active dorsiflexion when the anterior tibial muscles are paralyzed from drop foot. I use it for permanent foot drop from common peroneal nerve injury, stroke, Charcot-Marie-Tooth disease, or other neuromuscular conditions. The transferred tendon must be retrained through intensive physical therapy. Outcomes are best when surgery is performed within 12-18 months of onset.
Dr. Tom Biernacki, DPM is a board-certified foot & ankle surgeon (ABFAS & ABPM) 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 made him one of the most-followed foot & ankle educators on YouTube.
More questions patients ask
What conditions are treated with tibial tendon transfer?
Tibial tendon transfers are used for foot drop from peroneal nerve palsy, equinus from spasticity (cerebral palsy), tibialis anterior rupture, and residual clubfoot deformity. The transfer uses a working tendon to substitute for a paralyzed or absent one.
What is the split tibialis anterior tendon transfer (SPLATT)?
The SPLATT procedure transfers half of the tibialis anterior tendon laterally to balance a varus foot in cerebral palsy or spastic hemiplegia. By redirecting part of the muscle's pull, it corrects inversion without eliminating dorsiflexion power, producing a more plantigrade foot.
How long does recovery from tibial tendon transfer take?
Immobilization for 4–6 weeks, followed by intensive physical therapy to re-educate the transferred muscle into its new function. Most patients achieve functional improvement within 6–9 months. Strengthening the new tendon pathway requires consistent rehabilitation — passive immobilization alone does not produce good outcomes.
Still have a question about coverage or cost? Book online and we will check your benefits before your visit: Book in Howell · Book in Bloomfield Township. Prefer to talk it through first? Call (810) 206-1402.