Tendon Transfer Goals for Common Peroneal (Fibular) Nerve Palsy
Tendon transfer for common peroneal nerve injury most commonly targets restoration of active ankle dorsiflexion (foot lift) rather than guaranteed correction of foot eversion/inversion balance. [1][2] Standard posterior tibial tendon transfer procedures for chronic peroneal palsy are described as reliable for reconstructing dorsiflexion. [3][2]
Typical Functional Problem After Common Peroneal Nerve Injury
Common peroneal nerve palsy produces loss of ankle dorsiflexion from anterior compartment weakness. [4] Common peroneal nerve palsy also produces loss of foot eversion from peroneus longus and peroneus brevis weakness. [4]
Posterior Tibial Tendon Transfer (Most Common “Drop-Foot” Tendon Transfer)
The posterior tibialis tendon transfer through the interosseous membrane to the dorsum of the foot is described as restoring active ankle dorsiflexion where it has been lost. [2][3] The typical clinical description of this procedure emphasizes restoration of dorsiflexion and reduced need for bracing rather than independent restoration of eversion as a primary outcome. [3][1]
Inversion/Eversion Correction From the Transfer Vector
The transferred posterior tibial tendon re-routes to the dorsum of the foot to create a line of pull that produces dorsiflexion. [2] Because hindfoot eversion requires peroneal eversion force, standard dorsiflexion-focused transfers are not described as recreating normal peroneal-driven eversion by themselves in typical operative descriptions. [4][1] Some newer or multi-tendon strategies are reported to be designed to improve overall balance of the dorsiflexion-foot position rather than only producing dorsiflexion. [5][1]
Monotherapy Versus Combination Tendon Strategies
A single posterior tibial tendon transfer is commonly performed for dorsiflexion restoration in chronic peroneal palsy. [3][2] Multi-tendon approaches have been described for drop-foot deformity in common peroneal nerve palsy with the intent of improving a more balanced foot position. [5][1]
Initiation and Expectations After Tendon Transfer
Posterior tibial tendon transfer is used when foot drop persists from irreparable common peroneal nerve dysfunction, with the procedure framed around reliable dorsiflexion restoration. [3][2] Functional outcomes are therefore generally expected for dorsiflexion restoration, while eversion correction is less consistently emphasized as a primary deliverable in standard technique descriptions. [3][1][4]
Common Pitfall: Interpreting “Foot Drop” as a Single-Plane Problem
Foot drop from common peroneal palsy is not limited to dorsiflexion loss. [4][1] Hindfoot eversion loss contributes to the gait pattern, but standard tendon transfer discussions of posterior tibial transfer emphasize dorsiflexion restoration rather than full normalization of eversion. [3][1]
Direct Answer to the Version Question
Most commonly used tendon transfers for common peroneal nerve palsy primarily correct dorsiflexion. [3][2] Correction of inversion/eversion (foot version) is not the uniformly guaranteed effect of the standard dorsiflexion-focused posterior tibial tendon transfer. [4][1] More complex transfer constructs are reported in the literature with the aim of improving overall foot balance beyond simple dorsiflexion. [5][1]