Tendon Transfers

Tendon transfers are surgical procedures that move a tendon from its normal point of anchorage to another. This is done for a number of different reasons. Tendon transfers can correct deformity, improve joint function, or establish a better foot shape.

Symptoms and Clinical Presentation

​Muscle or tendon weakness can cause problems with gait (walking), instability of the ankle or foot, or changes in the underlying architecture of the foot. The specifics of a patient’s symptoms depend on the specific muscle/tendon or group of muscles/tendons that are not functioning properly.

Muscle deficits can be limited to one muscle group. An injury to the nerve that powers a muscle causes weakness of that muscle. Nerve injury to the muscle that lifts up the foot (dorsiflexion) causes a foot drop.

More complex patterns of weakness can occur, as seen in Charcot-Marie-Tooth disease. Many patients with this nerve disorder have an imbalance in the relative strengths of the lower limb muscles. This may cause a high foot arch and inward-turned heel.

Tendon transfers may be used for these and other conditions to restore strength and balance.

Cause (including risk factors)

​A wide variety of problems may cause muscle or tendon weakness. These include hereditary (genetic) neurologic diseases, stroke, other neurologic injury, trauma, or wear and tear.

Anatomy

​The foot is a unique weight-bearing structure, specifically designed for normal efficient gait (walking). The muscles of the lower leg are connected to tendons that attach at specific points on the foot. During a normal step, these muscles and tendons move the ankle and foot to enable normal gait.

As we walk, a single limb normally undergoes heel strike, foot flat, heel off, and then toe off. As this is occurring, the opposite limb undergoes a similar, yet slightly staggered series of movements. The result is a fluid and efficient gait.

The muscles that drive the ankle and foot during normal gait are balanced. When certain muscles act to raise up the foot (dorsiflexion), counteracting muscles that push the foot down (plantarflexion) are inactive. This balance occurs across the ankle and foot. Underactivity or overactivity of a particular muscle or group of muscles can cause inefficient gait, instability, and deformity of the bones and joints.

Diagnosis

​Observations about how the foot hurts or how it may have changed may help the orthopedic surgeon to identify the specific problem. The physical examination is important to determine the diagnosis, establish the underlying cause, and define which muscle/tendon(s) or nerve(s) may be involved.

For treatment options for tendon transfers, please visit our Foot and Ankle Center.

 

*Source:  American Orthopaedic Foot & Ankle Society® http://www.aofas.org

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