Silver et al. dissected all muscles below the knee in five cadavers, measuring fiber lengths and weights to calculate relative strength and excursion for each muscle. The study asks whether 'muscle balance' — equal agonist-antagonist strength — is a valid or achievable goal in foot and ankle tendon transfer surgery.
When planning tendon transfers around the foot and ankle, select the donor muscle based on task-matched strength and excursion — not on restoring theoretical balance — and counsel patients that tendon lengthening for spastic equinus will improve passive range but will not increase active dorsiflexion if the muscle belly is already shortened.
Silver et al. dissected all muscles below the knee in five cadavers, measuring fiber lengths and weights to calculate relative strength and excursion for each muscle. The study asks whether 'muscle balance' — equal agonist-antagonist strength — is a valid or achievable goal in foot and ankle tendon transfer surgery.
When planning tendon transfers around the foot and ankle, select the donor muscle based on task-matched strength and excursion — not on restoring theoretical balance — and counsel patients that tendon lengthening for spastic equinus will improve passive range but will not increase active dorsiflexion if the muscle belly is already shortened.