Combined Posterior Tibial Tendon Transfer and Forefoot Reconstruction for Foot Drop and Forefoot Pain Secondary to Charcot-Marie-Tooth Disease: A Case Report and Literature Review

Foot drop is a debilitating condition characterized by impaired ankle dorsiflexion and is commonly associated with neuromuscular disorders such as Charcot-Marie-Tooth (CMT) disease. CMT1A, the most prevalent subtype, leads to progressive weakness of the anterior compartment musculature and a cavovarus deformity. Posterior tibial tendon (PTT) transfer remains a well-established surgical technique for restoring active dorsiflexion in cases of irreversible foot drop. We present the case of a 59-year-old female with CMT1A, diabetes mellitus, and peripheral neuropathy who developed progressive left-sided foot drop. Conservative treatment, including a custom ankle-foot orthosis (AFO), was initially attempted. Following failed conservative management, the patient underwent a PTT transfer through the interosseous membrane with interference screw fixation into the intermediate cuneiform. This was combined with a tendoachilles lengthening, hammertoe correction, and Weil osteotomies of the second and third metatarsals. Clinically, she achieved 4° of dorsiflexion above neutral, transitioned to regular footwear, discontinued AFO use, and returned to full functional activity. This case report reinforces the role of PTT transfer as an effective, single-stage reconstructive option for neuromuscular foot drop when combined with appropriate adjunctive procedures and structured rehabilitation.