Tendon Transfer Surgery for PTTD: What to Know

When posterior tibial tendon dysfunction progresses beyond what conservative treatments can address, tendon transfer surgery becomes a viable option. This procedure offers a way to restore foot function and eliminate pain for those with advanced PTTD.

What Is Tendon Transfer Surgery?

Tendon transfer surgery involves taking a functioning tendon and redirecting it to take over the job of a damaged or weakened tendon. In PTTD treatment, the most common approach is transferring the flexor digitorum longus (FDL) tendon to replace the function of the posterior tibial tendon.

The FDL tendon normally helps control toe movement. Since several other tendons can compensate for this function, sacrificing it doesn’t typically cause significant loss of mobility—but it can restore critical arch support.

Why Tendon Transfer Is Performed

Tendon transfer is typically considered when:

  • The posterior tibial tendon is severely damaged or degenerated
  • Conservative treatments have failed to provide relief
  • The foot has developed significant flatfoot deformity
  • The patient wants to maintain active lifestyle options

This procedure is often part of a broader surgical reconstruction rather than a standalone treatment.

The Surgical Procedure

During tendon transfer surgery, the surgeon:

  1. Makes an incision along the inside of the ankle and foot
  2. Harvests the flexor digitorum longus tendon
  3. Routes it to attach to the navicular bone (where the posterior tibial tendon normally inserts)
  4. May combine it with other procedures like osteotomies or ligament repair

The surgery typically takes 2-3 hours and is performed under general anesthesia. Most patients stay in the hospital for 1-2 nights.

Recovery Timeline

Recovery from tendon transfer surgery follows a gradual progression:

Weeks 1-4: Strict immobilization in a splint or cast. Weight-bearing is not allowed.

Weeks 4-8: Transition to a removable boot. Physical therapy begins with gentle Range of motion exercises.

Weeks 8-12: Weight-bearing gradually resumes. Strengthening exercises intensify.

Months 3-6: Return to most normal activities. Continued strengthening.

Months 6-12: Full recovery and return to high-impact activities.

Success Rates and Outcomes

Tendon transfer surgery has excellent success rates when performed appropriately:

  • Pain relief: 85-90% of patients experience significant pain reduction
  • Function restoration: Most patients return to previous activity levels
  • Arch restoration: The transferred tendon effectively supports the arch

Factors affecting outcomes include patient age, surgical technique, and commitment to rehabilitation.

What to Consider

Before opting for tendon transfer surgery:

  • Get multiple professional opinions
  • Ensure your surgeon has extensive experience with this procedure
  • Commit to the full rehabilitation process—it’s essential for success
  • Understand that this is often combined with other procedures for comprehensive correction

Tendon transfer offers a reliable solution for severe PTTD, helping patients return to the activities they love with reduced pain and improved foot function.