Although the use of split tibialis anterior tendon transfer (combined with the Rose calcaneal osteotomy and reinforcement of the spring ligament) is a recognised procedure in the treatment of stage II tibialis posterior dysfunction, there is a paucity of data regarding its results. Forty-three patients who underwent reconstruction between 1997 and 2003 were evaluated pre- and postoperatively using the AHS scoring system. The average age was 57, and the mean follow-up time was 51 months (range 10–83).

The average AHS score pre-op. was 58 and post-op. was 85. Sixty-six per cent of patients achieved single heel raise. Eighty-four per cent expressed a subjective satisfaction rate, whilst 16% had no improvement. Seventy-eight per cent were able to use normal shoes and 58% did not require the use of any orthotics. The minor complication rate was 16% with no major complications. All osteotomies united uneventfully. Two patients have developed subtalar osteoarthritis, and six calcaneal screws had to be removed for prominence and tenderness.

Our results compare very favourably with other less anatomical reconstructions, but without the donor site morbidity and very low complication rates. A subjective satisfaction rate of 84% has been achieved.