Concierge foot & ankle · UK
Foot drop surgery, by a consultant foot & ankle surgeon.
A proper reconstruction by a BOFAS surgeon — nerve decompression, nerve transfer or tibialis posterior tendon transfer, chosen for your nerve, your muscle and your time-course. Non-surgical options are exhausted first.
Why patients choose us
- 01
A consultant foot & ankle surgeon, in theatre
Not a general orthopaedic list. A named BOFAS surgeon, a proper theatre, and a plan built for your nerve — not a template.
- 02
Non-surgical options exhausted first
A carbon-fibre AFO or functional electrical stimulation fixes many people. We say so before you commit to a tendon transfer.
- 03
Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Indicative pricing
What foot drop surgery costs privately in the UK.
Indicative ranges across our partner clinics. Send the details and we quote firm figures across two or three options.
In short
A tibialis posterior tendon transfer in our network: £9,000–£14,000, one to two nights on the ward.
| Procedure | Indicative range | Typical duration | Admission |
|---|---|---|---|
| Common peroneal nerve decompression | £6,500–£10,000 | 60–90 min | 1 night |
| Nerve transfer (tibial to deep peroneal) | £10,000–£16,000 | 120–180 min | 1–2 nights |
| Tibialis posterior tendon transfer | £9,000–£14,000 | 120–150 min | 1–2 nights |
| Bridle procedure (TP + FDL/PL) | £10,000–£16,000 | 150–180 min | 1–2 nights |
| Triple arthrodesis (static correction) | £11,000–£16,000 | 150 min | 2 nights |
| Consultation, nerve studies and MRI | £900–£1,800 | Half-day | 3–5 days |
Prices vary by hospital, by which surgeon does the case, by the complexity of the reconstruction, and by whether any extra work (Achilles lengthening, hindfoot correction) is added at the same sitting. NHS-funded surgery is available through specialist foot and ankle units.
The problem
The right cause, the right window, the right operation.
Foot drop is a symptom, not a diagnosis. Get the cause wrong, or miss the window for nerve surgery, and the wrong operation is done — or the right one is done too late. We fix both before you commit.
-
Not sure of the cause?
Nerve conduction, EMG and an MRI of the lumbar spine and peroneal nerve tell us whether it is nerve, root or muscle. We arrange all three.
-
Missed the nerve window?
Past 18 months, nerve repair and transfer stop working. A tendon transfer becomes the only useful reconstruction — we say so honestly.
-
Want the AFO off?
A BOFAS surgeon, a proper theatre, and a physiotherapy plan that runs for a year — the only realistic path back to walking without the brace.
The journey
From enquiry to walking without the brace — what happens, in order.
One clinician from first message to twelve-month review — including the physiotherapy plan.
Phase 1 · Before your procedure
Concierge, off-stage for you
Phase 2 · Admission
One to two nights on the ward
Phase 3 · After
Concierge, back on
- 01
Before
You tell us what is going on
A short, confidential form. When the weakness started, whether it followed injury or back trouble, and how much it is affecting your walking.
- 02
Before
We come back with a recommendation
Within one working day: which investigations you need (nerve conduction, EMG, MRI lumbar spine and nerve), the right surgeon, and an indicative price.
- 03
Before
We arrange the appointment
Usually within one to three weeks. Any blood-thinning medication is reviewed with the team and you are told exactly how to prepare.
- 04
Admission
Arrival at the hospital
Arrival, consent and a chat with the surgeon and anaesthetist. GA with tourniquet — standard for foot and ankle reconstruction.
- 05
Admission
The procedure itself
60 to 180 minutes in a proper theatre, depending on whether it is a decompression, nerve transfer or tendon transfer. Cast applied at the end.
- 06
Admission
One to two nights on the ward
Pain control, elevation, and a physio visit before discharge. You will go home non-weight bearing on crutches.
- 07
After
Recovery and re-education
Cast for four to six weeks, boot for another four to six, then months of physiotherapy to retrain the motor pattern. Expect a full year to know the result.
Typical end-to-end: 3–6 weeks from enquiry to theatre. Full re-education: 12 months.
When it helps
When foot drop surgery is the right step.
The situations we see most, plus the one red flag that means an emergency rather than an appointment.
-
Common peroneal nerve palsy
Weakness after a fibular-head injury, prolonged cross-legged posture, plaster cast or hip/knee surgery — often reversible if caught early.
-
L4/L5 radiculopathy
A disc prolapse or lateral recess stenosis compressing the L5 nerve root — spinal work comes first, foot surgery second.
-
Sciatic nerve injury
High injuries after hip surgery, penetrating trauma or gluteal injections — the peroneal division is the most vulnerable.
-
Charcot–Marie–Tooth disease
A slowly progressive hereditary neuropathy — tendon transfers and arthrodesis restore a plantigrade foot when orthotics stop coping.
-
Post-stroke or MS foot drop
Central weakness with preserved distal muscle bulk — functional electrical stimulation is usually first-line, not surgery.
-
Catching toes, tripping, falls
A steppage gait, tripping on kerbs and repeated falls — the functional picture that drives most referrals.
-
Failed orthotic trial
A proper AFO trial for three to six months without adequate function — the point at which reconstruction becomes reasonable.
-
Red flag: acute painful foot drop
Sudden weakness with severe back pain, saddle numbness or bladder trouble is cauda equina until proven otherwise — same-day A&E, not a clinic booking.
Procedure options
Tendon transfer is not the only option.
What each option on the table actually involves — and which fits which nerve, which muscle and which time-course.
-
Fibular head decompression
For an entrapped common peroneal nerve at the fibular neck — external neurolysis, sometimes with primary repair. Best within months of onset.
-
Nerve repair or cable graft
For a cleanly divided nerve — primary repair, or a sural nerve cable graft for gaps. The window is short: months, not years.
-
Tibial to deep peroneal nerve transfer
A branch of the tibial nerve (to tibialis posterior) is rewired to the deep peroneal — restoring true dorsiflexion. Done within 12–18 months of denervation.
-
Tibialis posterior tendon transfer
The TP tendon is routed through the interosseous membrane to the dorsum of the foot — a proven compensation when the nerve cannot be restored.
-
Bridle procedure
TP transfer combined with flexor digitorum longus and peroneus longus — a three-tendon sling giving a more balanced dorsiflexion.
-
Triple arthrodesis
Fusion of the subtalar, talonavicular and calcaneocuboid joints — for a fixed hindfoot deformity, or when tendon transfer alone cannot correct the shape.
-
Implantable FES (STIMuSTEP)
An implanted nerve stimulator that lifts the foot at each step — an alternative to surgery when external FES works but is impractical.
-
Consultation only
An honest discussion of whether surgery is needed at all — and which technique fits your nerve, your muscle and your goals.
Our vetted UK network
A small panel of foot & ankle surgeons, we picked them.
BOFAS-listed consultants with a subspecialist interest in peripheral nerve and tendon transfer surgery. Not listed publicly — introductions are made privately, once we understand your case.
Selection criteria
How we choose every surgeon in our network.
-
Consultant foot & ankle surgeons on the BOFAS register
-
Peripheral nerve surgery available for transfers and grafting
-
Neurophysiology (nerve conduction and EMG) arranged in-house
-
Specialist foot and ankle physiotherapy for the full 12-month re-education
Safety and recovery
What to expect afterwards — honestly.
Foot drop reconstruction is safe in the right hands, but it is a serious undertaking. The things worth planning are the twelve-week non-weight-bearing period, the physiotherapy, and the realistic goal of the operation.
-
Non-surgical options come first
A carbon-fibre AFO (ToeOFF or Blue Rocker), functional electrical stimulation (WalkAide, L300 Go) and gait re-education fix many patients. Surgery is not the default.
-
Timing is everything for the nerve
Nerve repair, grafts and transfers work best within 12–18 months of denervation. Miss the window and the muscle is not salvageable — tendon transfer becomes the only option.
-
GA and tourniquet, one to two nights
These are proper theatre cases, not day surgery. A GA with regional block, tourniquet on the thigh, and a short admission for pain control and elevation.
-
Non-weight bearing for four to six weeks
Crutches or a knee-scooter, cast then boot. Living arrangements matter — plan the ground floor, plan the shower, and plan for help.
-
Physiotherapy for six to twelve months
A tendon transfer or nerve transfer is only as good as the re-education. Expect months of retraining before the new pattern feels automatic.
-
Donor tendon weakness
A TP transfer sacrifices the arch-supporting function of tibialis posterior. Most patients develop a flexible flat foot afterwards — usually mild, occasionally symptomatic.
-
Compensation, not full restoration
Tendon transfer restores a functional gait, not a normal one. The honest goal is walking without an AFO and without tripping — not sprinting.
-
General surgical risks
Wound complications, stiffness, DVT and infection are uncommon but real. Achilles tightness and hindfoot deformity are addressed at the same sitting when present.
-
Red flags
Fever, spreading redness, a numb foot after the block should have worn off, or a swollen painful calf are not normal — call the on-call team or A&E the same day.
Reading your operation note
Your operation note in four parts. Read the last one first.
Whichever technique was used, the note the surgeon sends you keeps to the same shape.
A quiet reminder
Surgical language is precise and can read coldly — we translate it for you.
If you would like us to talk you through the note before your review, just ask.
- 01 Header
Aetiology and timing
Why the surgery was needed — peroneal palsy, L5 radiculopathy, CMT — and how long the muscle had been denervated. This tells you what recovery is realistic.
- 02 Technique
Nerve, tendon or bony work performed
Whether it was a decompression, a nerve transfer, a tibialis posterior transfer, a Bridle procedure or a fusion — and any Achilles lengthening done at the same sitting.
- 03 Findings
Muscle quality and intra-operative notes
The state of the recipient muscle, the tension set on the transfer, and the fixation used at the cuneiform. Details that predict the eventual dorsiflexion.
- 04 Impression
Cast, weight-bearing and physio plan
Read this first: how long in cast, when the boot starts, when weight-bearing begins, and the physiotherapy protocol for the next twelve months.
Recognised by major UK insurers
Cover for foot drop surgery varies by insurer and by cause — usually funded when medically indicated. We confirm cover before booking.
Frequently asked
Everything we get asked about foot drop surgery.
Quick answers on causes, timing, cost, recovery, and whether you will still need the AFO afterwards.
-
What is foot drop, and why does it happen?
Foot drop is weakness or paralysis of ankle dorsiflexion — the tibialis anterior and peroneal muscles that lift the front of the foot. The commonest UK causes are common peroneal nerve palsy at the fibular head, L4/L5 disc prolapse, sciatic nerve injury after hip surgery or trauma, Charcot–Marie–Tooth disease, MS and stroke.
-
Do I need surgery, or will an AFO be enough?
For many people an AFO is enough — a carbon-fibre ToeOFF or Blue Rocker restores a normal gait for most everyday activity. Functional electrical stimulation (WalkAide, L300 Go) suits central causes such as stroke and MS. Surgery is for people whose nerve is potentially recoverable, or whose orthotic and FES trial has been fair and has failed.
-
How soon after the injury should I have surgery?
The window matters. Decompression at the fibular head and primary nerve repair are ideally done within weeks to months. Nerve transfers work within 12–18 months of denervation. After that the target muscle is fibrotic and tendon transfer is the only useful reconstruction.
-
What is a tibialis posterior tendon transfer?
The tibialis posterior tendon is detached from its normal insertion, routed through the interosseous membrane between the tibia and fibula, and reattached on the dorsum of the foot at the lateral cuneiform. It compensates for the lost dorsiflexors and lets you walk without an AFO in most cases.
-
How much does foot drop surgery cost privately in the UK?
Roughly £6,500–£10,000 for a peroneal nerve decompression, £9,000–£14,000 for a tibialis posterior tendon transfer, and £10,000–£16,000 for a nerve transfer or Bridle procedure. Investigations (nerve conduction, EMG and MRI) add £900–£1,800. NHS-funded surgery is available through specialist foot and ankle units.
-
How long is the recovery?
Non-weight bearing in a cast for four to six weeks, then a boot for another four to six. Physiotherapy runs for six to twelve months to retrain the motor pattern. Most patients know their final result at around a year, and can walk without an AFO indoors well before then.
-
Will my foot be normal afterwards?
Honestly, no — tendon transfer is a compensation, not a restoration. The realistic goal is walking without tripping, without an AFO, on level ground and stairs. Sprinting and jumping do not usually come back. Nerve transfers can restore closer-to-normal function if done early enough.
-
Will I still need an AFO after surgery?
Many patients drop the AFO for indoor and everyday walking within three to six months. Some still use one for long distances, uneven ground or sport. This is not a failure — it is a normal part of the outcome we discuss with you before you consent.
-
When should I see a doctor urgently?
A sudden painful foot drop with severe back pain, saddle-area numbness or trouble passing urine is cauda equina syndrome until proven otherwise — that is a same-day A&E problem, not a clinic booking. New weakness after hip or knee surgery also warrants an urgent review.
Related tests
Looking for something else?
-
Functional electrical stimulation
Non-surgical foot-lift for stroke, MS and CMT.
Learn more -
Foot & ankle physiotherapy
Gait re-education after nerve or tendon surgery.
Learn more -
All tests
Every test and procedure we arrange.
Learn more -
Enquire
Tell us what is going on — we come back within a day.
Learn more
Nearby in the library