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

TL;DR

A 59-year-old woman with CMT1A and foot drop underwent successful surgery combining tendon transfer and forefoot reconstruction, restoring function and eliminating the need for an orthosis.

Contribution

This case report demonstrates the effectiveness of combined PTT transfer and forefoot procedures for CMT-related foot drop.

Findings

The patient achieved 4° of dorsiflexion above neutral post-surgery.

She transitioned to regular footwear and discontinued AFO use.

The procedure enabled a return to full functional activity.

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.

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