Functional and quality of life outcomes after tibialis posterior transfer for foot drop from peroneal nerve injury

OBJECTIVE: To identify which functional domains show the greatest improvement in patients with foot drop (FD) due to common peroneal nerve (CPN) injury treated with tibialis posterior tendon transfer (TPTT). DESIGN: Ambispective, longitudinal, nonrandomized study. SETTING: Tertiary academic hospital. PARTICIPANTS: Nineteen patients (15 men; mean age 29.5 ± 13.3 years) with FD secondary to CPN injury who underwent TPTT between 2018 and 2022. INTERVENTIONS: TPTT performed via circumtibial route with standard postoperative rehabilitation protocol. MAIN OUTCOME MEASURES: Functional outcomes assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) score at baseline and at 1, 3, 6, and 12 months postoperatively. Repeated measures ANOVA and effect sizes (Cohen's d) were calculated (α = 0.05, β = 0.01). RESULTS: Mean AOFAS scores significantly increased from 46.58 ± 10.2 preoperatively to 87.1 ± 9.94 at 12 months postoperatively (p= 1.10 x 10⁻²², d = 3.739). The most significant improvements were observed in walking on different surfaces (p = 1.33 × 10⁻¹⁹, d = 10.668), foot alignment (p = 3.50 × 10⁻¹⁵, d = 6.009), and reduction in daily activity limitations (p = 1.29 × 10⁻¹², d = 4.277) CONCLUSIONS: TPTT significantly improves function in patients with FD due to CPN injury. The most notable functional gains are seen in surface walking ability, likely reflecting improved foot alignment and decreased claw toe formation. These findings support TPTT as an effective intervention for enhancing mobility and quality of life in this population.