Tibialis Posterior Tendon Transfer

The Tibialis Posterior Tendon Transfer for Foot Drop procedure is a surgical solution for patients suffering from foot drop, a condition where there is a loss of dorsiflexion, leading to difficulty in lifting the foot during walking. 

This condition can occur due to several reasons, including nerve injuries (such as peroneal nerve damage), neurological disorders, and trauma. Foot drop can severely affect gait, leading to high stepping, foot slapping, and difficulty in clearing the foot during the swing phase of walking. This page provides a detailed overview of the procedure, its indications, planning, surgical steps, and post-operative recovery.

Foot drop is a common condition resulting from nerve injury or neurological conditions, such as peroneal nerve damage, cerebral palsy, multiple sclerosis, and stroke. It affects individuals of all ages but is more common in older adults due to the prevalence of nerve injuries and neuropathies.

Causes

Foot drop occurs when there is a loss of dorsiflexion due to dysfunction in the peroneal nerve, tibialis anterior muscle, or other structures responsible for foot movement. Nerve injuries, compartment syndrome, and neuromuscular diseases are the most common causes of foot drop. It can lead to a high-stepping gait and difficulty with normal walking patterns.

The tibialis posterior tendon plays a critical role in controlling ankle movement and supporting the arch of the foot. In foot drop, the tibialis anterior tendon is usually compromised, preventing proper dorsiflexion. Tibialis posterior tendon transfer helps compensate for this loss by rerouting the tendon to improve foot movement.

What You Might Feel

Symptoms of foot drop include difficulty lifting the foot, especially when walking or during the swing phase. This leads to a high-stepping gait, foot slap, and an inability to clear the ground with the foot. These symptoms can cause tripping, instability, and difficulty walking for extended periods.

Diagnosis and Imaging

Foot drop is diagnosed through clinical examination, including testing gait, foot position, and strength. Imaging studies such as X-rays or MRI scans are used to rule out other conditions, such as fractures or arthritis, and confirm the underlying cause of the foot drop, particularly nerve damage.

Treatment Options

Non-Surgical Care:

• Bracing: A foot drop brace (AFO) helps support the foot and improve gait.
• Physical Therapy: Strengthening exercises for the foot and ankle can help compensate for weakness.
• Orthotics: Custom shoes or insoles may be used to improve foot alignment and reduce discomfort.

Surgical Care:

• Tibialis posterior tendon transfer is the primary surgical treatment for foot drop when nerve recovery is not expected, rerouting the tendon to improve dorsiflexion.

Following tibialis posterior tendon transfer surgery, patients are placed in a non-weight-bearing cast for several weeks. Gradual weight-bearing is allowed after this period, and physical therapy is initiated to restore function. Full recovery can take several months, depending on individual healing progress.

Possible Risks or Side Effects

• General Risks: Infection, scarring, nerve injury, and blood clots are common risks with any surgical procedure.
• Specific Risks: Failure of the tendon transfer, further surgery, or complications like compartment syndrome.
• Postoperative Rehabilitation: Avoiding passive plantarflexion during rehabilitation is essential to prevent tendon detachment or stretching.

Insurance & Cost

Tibialis Posterior Tendon Transfer at Complete Orthopedics is covered by Medicare and most major insurance carriers (Aetna, Anthem BCBS, Cigna, Empire BCBS, UnitedHealthcare), as well as most workers’ compensation and no-fault insurance plans. Your out-of-pocket cost depends on your specific plan, deductible, and the medical necessity criteria that apply to your case.

Call our billing team at (631) 981-2663 before scheduling to verify your coverage and discuss expected out-of-pocket costs. For the full list of carriers we accept and patient billing protections, see our Insurance Information page.

Summary and Takeaway

Tibialis posterior tendon transfer is a highly effective solution for foot drop caused by nerve damage, trauma, or neuromuscular conditions when nerve recovery is not expected. This surgical intervention restores dorsiflexion, improves gait, and enhances overall foot function. With a high success rate and low complication risk, tibialis posterior tendon transfer significantly improves patients’ mobility and quality of life. Comprehensive post-operative care, including physical therapy, is crucial for achieving optimal results and preventing complications.