Tendon transfers for peripheral nerve injuries of the lower extremity

1. Nerve injuries in the lower extremity not infrequently result in paralysis of the muscles innervated by the injured nerve. 2. Disability caused by residual paralysis can be reduced by appropriate muscle transfers. 3. Deformity must be corrected before muscle transfer. 4. The most useful transfers in the lower extremities are the transfer of the tibialis posterior tendon anteriorly for correction of the equinovarus deformity of peroneal nerve injury; the transfer of the tibialis anterior with or without the peroneus longus to the calcaneus to prevent calcaneus deformity caused by loss of the triceps surae; and the transfers of the biceps femoris and semitendinosus to the patella to replace a paralyzed quadriceps. 5. Stability in the lower extremity is of prime importance and, if significant foot deformity is present at the time of transfer, a triple or subtalar arthrodesis is indicated as an associated procedure in transfers about the ankle.