What Is a Flexor to Extensor Tendon Transfer?

This surgery is used to treat flexible hammertoe deformity. A hammertoe deformity is one in which the toe is bent and looks like a hammer. A flexible deformity is one in which the toe can be manipulated into a straight position. This deformity can cause shoe problems, corns, and pain with walking.

This procedure also can be used to treat conditions in which the toe deviates or crosses over the remaining toes, such as a plantar plate injury. Prior to considering surgery, a course of non-surgical treatment should be attempted, including shoe modification, splinting, and toe sleeves.

The goals of the surgery are to improve the alignment of the toe and reduce pain, eliminate any prominences, and improve shoe accommodation.

Patients with a history of poor circulation and loss of feeling in the feet and toes are at higher risk of wound healing problems, infection, and compromise of the blood flow to the toe. If you have any of these symptoms, you should discuss the risks and benefits of surgery with your foot and ankle orthopaedic surgeon.


This surgery is performed as an outpatient procedure, meaning the patient can go home the same day. The patient may be under general anesthesia or awake with numbing medication injected into the foot. A tourniquet is applied to your foot to minimize blood loss.

Your foot and ankle orthopaedic surgeon makes an incision on the bottom of the involved toe. There are two tendons to each toe that help to flex or bend the toe. One of the tendons is transferred to the top of the toe. It is then attached to the tendon that extends or straightens the toe through an incision on the top of the toe. A pin may be inserted into the toe to help maintain alignment for a number of weeks after the procedure. 


Patients typically are allowed to walk after the procedure in a post-operative shoe. If other procedures are done simultaneously, this may restrict your ability to weight bear for a period of time after surgery. Sutures generally are removed two weeks after surgery. The toe sometimes is taped to help maintain alignment for several weeks. Patients can be allowed to return to regular shoes approximately four to six weeks after surgery. Swelling can be expected within the toe, possibly for many months after surgery.

Risks and Complications

All surgeries come with possible complications, including the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.

Complications from this procedure include stiffness of the toe and potential recurrence of the deformity. 

When can I return to work?

Return to work is variable and depends on the nature of your occupation. In general, return to a sedentary job can occur over a few days to two weeks. More physically demanding occupations will require a longer recovery.

When will I be allowed to drive?

If the surgery involves the non-driving foot, you can drive within a few days of surgery. If it involves the driving foot, it may be several weeks before you can drive. It is important to discuss this with your physician prior to undergoing surgery.


Original article by Sudheer Reddy, MD
Contributors/Reviewers: David Garras, MD; Zachary Vaupel, MD; Paul Ryan, MD

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