Tendon transfer for foot and ankle

You may need tendon transfer surgery if a key tendon in your foot or ankle has weakened to the point where it can no longer support proper alignment and function. Common reasons include: 

• Stage III or IV posterior tibial tendon dysfunction
• Progressive flattening or collapse of the foot's arch
• Foot or ankle pain that limits walking or daily activities
• Changes in foot shape that haven't improved with nonsurgical care
• Tendon weakness that continues to worsen despite bracing, orthotics or physical therapy 

Your foot and ankle specialist will evaluate your symptoms, foot alignment and imaging results to determine whether tendon transfer is the right next step for you.

Nonsurgical

Before considering surgery, we often start with conservative care to reduce pain and slow the progression of tendon dysfunction. Nonsurgical options may include: 

• Custom orthotics to improve alignment and reduce tendon strain
• Bracing with ankle-foot orthoses (AFOs) to stabilize the foot and prevent further collapse
• Physical therapy to strengthen and stretch supporting muscles and tendons
• Medication, such as NSAIDs, to manage pain and inflammation
• Activity modification to help you stay active while protecting the foot 

Surgical 

When nonsurgical treatments no longer provide enough relief, surgical options may include: 

• Flexor digitorum longus (FDL) transfer, the most common approach, which reroutes the FDL tendon behind the ankle bone to support the arch
• Combination procedures, often paired with calcaneal osteotomy (heel bone realignment) and spring ligament repair for more complete correction
• Minimally invasive techniques when appropriate, using smaller incisions to help reduce recovery time and scarring 

Your care team will recommend the option that best fits your tendon damage, activity level and goals. 

Recovery after tendon transfer surgery happens in stages, with your care team guiding you through each phase: 

• Weeks 1 to 6: Non-weightbearing in a cast or boot while swelling management begins
• Weeks 6 to 12: Gradual, protected weightbearing in a walking boot along with physical therapy focused on strength, motion and balance
• Three to six months: Transition to supportive shoes and custom orthotics as most patients resume daily activities
• Six to 12 months: Full return to recreational activity for appropriate candidates 

After recovery, your care team will guide you in using custom orthotics, supportive footwear and targeted exercises to maintain arch support, protect the tendon transfer and help prevent recurrence. 

As with any surgery, tendon transfer carries some risks, including infection, stiffness, nerve irritation or the need for further treatment if the tendon transfer doesn't fully resolve symptoms. Recovery can take several months, and following your rehabilitation plan closely supports the best possible outcome. 

Your foot and ankle care team will talk with you in detail about the risks and benefits of tendon transfer surgery before you decide on treatment, and they'll answer any questions you have along the way.