FDL Tendon Transfer with Calcaneal Osteotomy
The standard reconstruction for flexible adult acquired flatfoot — the flexor digitorum longus (FDL) tendon is transferred to replace the failed posterior tibial tendon, and the heel bone is realigned with a calcaneal osteotomy.
Medically reviewed by Michael G. Lyons, DPM — Board-Certified Foot and Ankle Surgeon
Written and reviewed by the physicians of Foot Health Centers, Hernando & Southaven, MS. Meet our doctors
- Flexible adult acquired flatfoot (stage II PTTD)
- Posterior tibial tendon failure with correctable deformity
Medial incision for FDL harvest and transfer to the navicular. A lateral incision allows medializing calcaneal osteotomy. Additional procedures (gastroc recession, lateral column lengthening) added as needed.
- Non-weightbearing 6–8 weeks
- Boot with progressive weightbearing weeks 8–12
- Physical therapy
- Return to regular shoes 4–5 months
- Full activity 9–12 months
- Wound healing
- Nerve injury
- Nonunion of osteotomy
- Recurrent deformity
Conditions this procedure treats
Posterior Tibial Tendon Dysfunction (PTTD)
Posterior tibial tendon dysfunction (PTTD) is the most common cause of adult-acquired flatfoot. The tendon that supports the arch becomes inflamed, stretched, or torn, leading to gradual arch collapse and pain on the inside of the ankle.
Learn moreAdult Acquired Flatfoot
Adult acquired flatfoot is the gradual collapse of the arch in adulthood — usually from posterior tibial tendon failure. Early intervention prevents progression to rigid deformity.
Learn moreFrequently asked questions
Will losing the FDL affect my toes?
The small toes still flex through other tendons — most patients notice no functional difference.
Request a surgical consultation
Tell us a little about what's going on — our team will follow up to schedule.
Ready to Get Relief?
Call Foot Health Centers to schedule your visit in Hernando or Southaven.