Medically reviewed by Dr. Tom Biernacki, DPM
Board-certified podiatric surgeon | Balance Foot & Ankle, Howell & Bloomfield Hills, 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 Hills, 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.