Abstract
There are many reasons for muscle imbalance around the foot and ankle but the most common is some form of neuromuscular disease. The etiology is obviously very important in the decision making of treatment options. One should be aware of the progression pattern of the disease or condition. The simplest imbalances to treat are those secondary to a static condition.
The initial goal is to determine what force couples are available, what can be used, is it an in phase, or out of phase muscle you want to transfer. Next is to determine if there are any contractures that will have to be addressed and equally important whether there are fixed skeletal deformities present. No tendon transfer will be able to overcome a fixed bony deformity, and those should be corrected prior to transferring muscles.
