Tibialis Posterior & FDL Tendon Transfers for Foot Drop

Injury to the common peroneal nerve can result in foot deformity and foot drop. Tibialis posterior tendon and flexor digitorum longus tendon transfers aim to restore foot function, reduce discomfort and produce a more normal way of walking.

Tibialis posterior tendon and FDL transfer surgery has a number of steps. These include:

• General anaesthetic, intravenous antibiotics
• Numerous incisions over the foot and the leg
• Lengthening of the Achilles tendon
• Exposure and harvesting of tendons
• Tendon transfers and insertion into bones using sutures and/or screws
• Closure of tendon sheath
• Closure of wound with stitches/sutures and infiltration of local anaesthetic
• Application of plaster back slab

All surgical procedures carry some risk. The risks of complications with tibialis posterior tendon and FDL transfer surgery are low. Some of the risks include:

• Infection
• Problems with wound healing
• Nerve injury causing numbness, tingling and/or pins and needles
• Tendon rupture
• Periprosthetic fracture
• Deep venous thrombosis/pulmonary embolism (the risk of DVT increases with smoking, the oral contraceptive pill and hormone replacement therapy, immobility and obesity)
• Anaesthetic complications
• Drug allergy
• Ongoing pain and deformity

Rest

• You will have a cast on your leg. Keep foot elevated as much as possible, especially for initial 72 hours. Keep dressings dry and intact until post operative appointment.
• Mobilise short distances as pain allows, aim to remain in your own home for the first few weeks limiting long periods of standing or mobilising
• Do not bear weight for the first six weeks

Pain

• Pain relief may be required for up to 4 weeks; depending on your other medications this may include:
• Regular paracetamol, anti-inflammatory drugs and break through opiate type medications
• A regular blood thinning medication will also be prescribed for 2 weeks

Driving

• Any surgery performed on the right foot or both feet will mean no driving for a minimum of 6 weeks
• If surgery was performed on the left foot then driving in an automatic is possible, but Dr Phegan would recommend waiting a minimum of two weeks before attempting to drive

Driving any vehicle with a cast or boot is potentially hazardous and you should consider this before getting behind the wheel.

Follow up

• Keep all dressings dry and intact for the first two weeks
• Removal of stitches/sutures typically occurs at an appointment with Dr Phegan and his in-house therapists at 10-14 days at first post operative appointment. Very occasionally some sutures need to stay in for longer
• Your appointment will be booked by Dr Phegan and a confirmatory SMS will be sent informing you of the time and date for follow up

Typical milestones

• 2 weeks: Wound review and removal of sutures, change from cast to boot, commence rehabilitation
• 2-6 weeks: regular physiotherapy to increase range of motion
• 6 weeks to 3 months: work on swelling reduction, scar massage and mobility. Progress weight bearing
• Full recovery 6-9 months

Every patient's recovery is individual and depends on the severity of the injury and the complexity of the surgery.