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

Sep 29, 2026

Foot drop impairs ankle dorsiflexion and often arises from neuromuscular disease, including Charcot-Marie-Tooth (CMT). This open access case report describes a 59-year-old woman with CMT1A, diabetes mellitus, and peripheral neuropathy who developed progressive left-sided foot drop. After conservative care with a custom AFO failed, she underwent posterior tibial tendon transfer via the interosseous membrane with interference screw fixation, plus adjunctive tendoachilles lengthening, hammertoe correction, and Weil osteotomies. Postoperatively, she achieved dorsiflexion above neutral, transitioned to regular footwear, discontinued AFO use, and resumed full functional activity, supporting this single-stage reconstructive approach with structured rehabilitation.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages7

Reading Time18 min

AccessFree to download

Introduction

Case Presentation

Patient history and initial presentation

How to cite this article

Review began 11/25/2025 Review ended 12/27/2025 Published 01/04/2026 © Copyright 2026 Moss et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.100753 Open Access Case Report 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 Mark H. Moss 1, Angela M. Garcia 2 1. Podiatry, Coastal Foot and Ankle Associates, Pearland, USA 2. Podiatry, HCA Houston Healthcare West Residency Program, Houston, USA Corresponding author: Mark H. Moss, [mm@coastalfaa.com](mm@coastalfaa.com) Abstract 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. Categories: Podiatry, Orthopedics Keywords: charcot-marie-tooth disease, drop foot, interosseous membrane, outcome measure, posterior tibialtendon Introduction Foot drop is a debilitating deformity characterized by impaired dorsiflexion at the tibiotalar joint. It most commonly results from neuromuscular disease or injury to the common peroneal nerve. The resulting gait disturbance significantly impairs functional mobility and quality of life. Charcot-Marie-Tooth (CMT) disease is a progressive hereditary peripheral neuropathy caused by defective myelination of peripheral nerves. The most common form is CMT type 1, with subtype 1A linked to a duplication of the PMP22 gene on chromosome 17 [1] . Patients with CMT1A typically present with calcaneal varus foot deformity and weakness of the tibialis anterior and peroneal muscle groups. Management of CMT-associated foot deformities depends on the functional status of the remaining musculature and the progressive nature of the disease. Conservative options include orthotics, custom ankle-foot orthoses (AFOs), and physical therapy. Surgical intervention may be indicated based on deformity flexibility, patient goals, and neuromuscular function. Multiple tendon transfer procedures have been described, with posterior tibial tendon (PTT) transfer remaining a reliable and biomechanically effective option for restoring active dorsiflexion [2,3] . The procedure was first described by Ober in 1933 and later modified by Putti in 1937 to pass the tendon through the interosseous membrane, a technique further popularized by Watkins in 1954 [2,4,5]. Successful PTT transfer requires careful consideration of the route of transfer, insertion site, fixation method, and wh

FAQs

What condition is being treated in this case report?

The report addresses foot drop and forefoot pain secondary to Charcot-Marie-Tooth disease, specifically in a patient with CMT1A.

What conservative treatment was tried before surgery?

A custom ankle-foot orthosis (AFO) and other conservative management were attempted initially but failed.

What surgical procedures were performed?

Posterior tibial tendon transfer via the interosseous membrane with interference screw fixation was combined with tendoachilles lengthening, hammertoe correction, and Weil osteotomies of the second and third metatarsals.

Sep 29, 2026

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