Foot Drop, Hindfoot Varus, and Tibialis Posterior Tendon Transfer in Cerebral Palsy

The transfer of the tibialis posterior tendon has been used to correct hindfoot varus and dorsiflexion weakness in cerebral palsy. It is expendable, has a favorable direction for dorsiflexion and eversion posterior to the tibia, and is the source of hindfoot varus in most cases. However, the foot and ankle must be flexible without skeletal deformity. The electromyography of the tibialis posterior should be present in the swing phase for the tendon transfer to function correctly. Techniques and pitfalls are described to plan and execute a successful tibialis posterior tendon transfer.