Expert Orthopedic Surgery in Nicholas Strasser MD

A posterior tibial tendon transfer, commonly called a “Bridle” tendon transfer, is a procedure used to restore the ability to lift the foot (dorsiflexion) in patients with foot drop.

Foot drop occurs when the muscles that lift the foot are weak or not working properly. This can lead to:

• Difficulty clearing the foot when walking
• A “slapping” or “steppage” gait
• Increased risk of tripping or falling

Common causes include:

• Nerve injuries (peroneal nerve palsy)
• Spine-related nerve compression
• Trauma or previous surgery
• Neurologic conditions

In this procedure, a functioning tendon (the posterior tibial tendon) is re-routed to the top of the foot and connected to other tendons.

This creates a “bridle” construct that allows the foot to be lifted again during walking.

Instead of relying on damaged muscles or nerves, the body uses a healthy tendon to restore function.

A Bridle tendon transfer is typically recommended when:

• Foot drop has not improved with time or bracing
• There is permanent nerve injury
• The goal is to improve walking without reliance on a brace
• The ankle joint is still mobile and healthy

The goal is to:

• Improve walking mechanics
• Reduce tripping risk
• Increase independence and function

Recovery from a Bridle tendon transfer is a structured, stepwise process. Healing is only part of the equation—retraining the tendon is just as important.

• You will be in a splint or cast
• No weight bearing on the surgical leg
• Focus is on protecting the tendon transfer

• Transition into a walking boot
• Gradual increase in weight bearing
• Begin gentle ankle motion

• Transition to a brace
• Begin physical therapy focused on:
  
  • Learning to lift the foot again
  • Gait training
  • Balance and coordination

• Progressive strengthening
• Improved walking mechanics
• Return to low-impact activity

• Gradual return to higher-level activities
• Some patients may still benefit from a brace depending on strength and goals

This surgery does not just “fix” the foot—it changes how your muscles work.

The tendon that used to support the arch is now responsible for lifting the foot.
That means your brain and body need time and repetition to relearn this movement.

Physical therapy plays a critical role in this process.

Most patients experience:

• Improved ability to clear the foot during walking
• A more normal gait pattern
• Reduced need for external bracing

However, it is important to understand:

• Strength may not return to completely normal
• Push-off strength can be slightly decreased
• Full recovery takes several months

A Bridle tendon transfer is best suited for patients with:

• Persistent foot drop
• Good joint mobility
• A desire to improve function beyond bracing

A detailed evaluation is required to determine if this is the right treatment option.

This is a reliable and well-established procedure that can significantly improve function in the right patient.

Success depends on:

• Proper patient selection
• Protecting the repair early
• Committing to rehabilitation