Single versus double tendon transfer for foot drop due to post-traumatic common fibular nerve palsy



To compare functional outcomes of single versus double tendon transfer for foot drop correction and toe drop prevention in posttraumatic common fibular nerve palsy.


A retrospective study was conducted on data from patients with posttraumatic common fibular nerve palsy treated by tendon transfer between 2001 and 2018. In cases of single tendon transfer (STT) the tibialis posterior (TP) tendon was transferred anteriorly through the interosseous membrane to a new insertion on the lateral cuneiform. In cases of double tendon transfer (DTT), the same TP tendon transfer was combined with a transfer of the flexor digitorum longus to the extensor digitorum longus and extensor hallucis longus tendons. Functional assessment was based on the Carayon score to evaluate foot drop correction and on the Yeganeh score to evaluate toe drop prevention.


A total of 27 patients were included: 13 in the STT group and 14 in the DTT group. Functional results were comparable between groups in terms of reduction of foot drop, active range of ankle motion and Carayon score. Prevention of toe drop, active toe extension and Yeganeh score were significantly greater in the DTT group, however, active toe extension of was only restored in only 8 cases in the DTT group.


Double transfer of TP and FDL tendons is a reliable method to restore balanced ankle dorsiflexion and prevent toe drop. However, recovery of active toe extension was inconsistent and Carayon scores were not superior to those obtained with a single TP tendon transfer.

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  1. 1.

    Mook WR, Ligh CA, Moorman CT, Leversedge FJ. Nerve injury complicating multiligament knee injury: current concepts and treatment algorithm. J Am Acad Orthop Surg. 2013;21:343–54.

    PubMed  Google Scholar 

  2. 2.

    O’Malley MP, Pareek A, Reardon P, Krych A, Stuart M, Levy BA. Treatment of peroneal nerve injuries in the multiligament injured/dislocated knee. J Knee Surg. 2016;29:287–92.

    Article  Google Scholar 

  3. 3.

    Ho B, Khan Z, Switaj PJ, Ochenjele G, Fuchs D, Dahl W, Cederna P, Kung TA, Kadakia AR. Treatment of peroneal nerve injuries with simultaneous tendon transfer and nerve exploration. J Orthop Surg Res. 2014;9:67.

    Article  Google Scholar 

  4. 4.

    Gürbüz Y, Sügün T, Özaksar K, Kayalar M, Toros T, Ademoğlu Y. Peroneal nerve injury surgical treatment results. Acta Orthop Traumatol Turc. 2012;46:438–42.

    Article  Google Scholar 

  5. 5.

    Carayon A, Bourrel P, Bourges M, Touzé M. Dual transfer of the posterior tibial and flexor digitorum longus tendons for drop foot. Report of thirty-one cases. J Bone Jt Surg Am. 1967;48:144–8.

    Article  Google Scholar 

  6. 6.

    Vigasio A, Marcoccio I, Patelli A, Mattiuzzo V, Prestini G. New tendon transfer for correction of drop-foot in common peroneal nerve palsy. Clin Orthop Relat Res. 2008;466:1454–66.

    Article  Google Scholar 

  7. 7.

    Grauwin MY, Wavreille G, Fontaine C. Double tendon transfer for correction of drop foot. Orthop Traumatol Surg Res. 2015;101:116–8.

    Google Scholar 

  8. 8.

    Shane AM, Reeves CL, Cameron JD, Vazales R. Posterior tibial tendon transfers. Clin Podiatr Med Surg. 2016;33:29–40.

    Article  Google Scholar 

  9. 9.

    Yeganeh MM. Triple tendon transfer for correction of foot deformity in common peroneal nerve palsy. Foot Ankle Int. 2016;37:665–9.

    Article  Google Scholar 

  10. 10.

    Cho BK, Park KJ, Choi SM, Im SH, SooHoo NF. Functional outcomes following anterior transfer of the tibialis posterior tendon for foot drop secondary to peroneal nerve palsy. Foot Ankle Int. 2017;38:627–33.

    Article  Google Scholar 

  11. 11.

    Lingaiah P, Jaykumar K, Sural S, Dhal A. Functional evaluation of early tendon transfer for foot drop. J Orthop Surg (Hong Kong). 2018.

    Article  Google Scholar 

  12. 12.

    Wagner E, Wagner P, Zanolli D, Radkievich R, Redenz G, Guzman R. Biomechanical evaluation of circumtibial and transmembranous routes for posterior tibial tendon transfer for drop foot. Foot Ankle Int. 2018;39:843–9.

    Article  Google Scholar 

  13. 13.

    Marsland D, Stephen J, Calder T, Amis AA, Calder J. Tibialis posterior tendon transfer for foot drop: strength of interference screw fixation to the cuboid versus Pulvertaft weave to peroneus brevis. Foot Ankle Int. 2018;39:858–64.

    Article  Google Scholar 

  14. 14.

    Krishnamurthy S, Ibrahim M. Tendon transfers in foot drop. Indian J Plast Surg. 2019;52:100–8.

    Article  Google Scholar 

  15. 15.

    Mathieu L, Addas BMJ, Irimura SC, Oberlin C, Belkheyar Z. Management of sciatic nerve defects: lessons learned and proposal for a new strategy. Ann Plast Surg. 2019.

    Article  Google Scholar 

  16. 16.

    Medical Research Council of the United Kingdom. Aids to the examination of peripheral nervous system. Memorandum No. 45, London, Her Majesty’s Stationery Office, 1976.

  17. 17.

    Agarwal P, Gupta M, Kukrele R, Sharma D. Tibialis posterior (TP) tendon transfer for foot drop: a single center experience. J Clin Orthop Trauma. 2020;11:457–61.

    Article  Google Scholar 

  18. 18.

    Jeng C, Myerson M. The use of tendon transfers to correct paralytic deformity of the foot and ankle. Foot Ankle Clin. 2004;9:319–37.

    Article  Google Scholar 

  19. 19.

    Pechera M, Devany A, Nourallah B, Cutts S, Pasapula C. Long-term follow-up of patients undergoing tibialis posterior transfer: is acquired pes planus a complication? Foot (Edinb). 2018;34:83–9.

    Article  Google Scholar 

  20. 20.

    Sturbois-Nachef N, Allart E, Grauwin MY, Rousseaux M, Thévenon A, Fontaine C. Tibialis posterior transfer for foot drop due to central causes: long-term hindfoot alignment. Orthop Traumatol Surg Res. 2019;105:153–8.

    Article  Google Scholar 

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The authors are grateful to Jennifer DANDREA for her contribution to the article writing.

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Correspondence to Laurent Mathieu.

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Mathieu, L., Achour, S., Oberlin, C. et al. Single versus double tendon transfer for foot drop due to post-traumatic common fibular nerve palsy. Eur J Trauma Emerg Surg (2021).

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  • Common fibular nerve palsy
  • Foot drop
  • Tibialis posterior tendon
  • Tendon transfer