Posterior tibial tendon transfer to dorsum of second metatarsal base. A, Posterior tibial tendon removed from insertion. Length can be effectively doubled by splitting at myotendinous junction to cut end. Secure midpoint at lengthened tendon with suture. B, Lengthened tendon is passed through hole in interosseous membrane (posterior to anterior) and subcutaneously across anterior aspect of ankle. C, Lengthened tendon is pulled subcutaneously across dorsum of midfoot, looped around base of second metatarsal, and sutured to itself with enough tension to hold ankle in neutral. SEE TECHNIQUE 35.5.