Ankle and foot tendon transfer (excluding paralytic foot and toe deformity)

It is essential to master the techniques of tendon transfer and to know the indications, so as to be able to treat tendinopathy, tendon tear or static deformity in the foot and ankle. The type of transfer depends on the pathology, with the aim of reconstructing or supplementing the affected muscle. Complete clinical and paraclinical assessment is needed to determine feasibility and draw up the preoperative plan according to axial deformity and associated retraction. Success depends on several factors: rigorous technique, fixation method, tension adjustment, immobilization, and rehabilitation. Stability is ensured by transosseous fixation with interference screw, or tenodesis. Tendon tension is crucial, but consensus is lacking; the general rule is to maximize tension according to the targeted effect. Postoperative immobilization is generally recommended, for 4-6 weeks, depending on associated procedures, indications and type of fixation. Rehabilitation is systematic, to reprogram gait with an altered motor schema. Muscle exercises against resistance should not be started before month 3. Once surgery has been indicated, the choice of transfer is made on a case-by-case basis. LEVEL OF EVIDENCE: >V: expert opinion.