Distal nerve transfer has been widely used to treat upper limb paralysis; however, its application in lower limb paralysis remains limited. Here, we report three cases of common peroneal nerve palsy treated with partial tibial nerve transfer. The patients developed foot drop following total hip arthroplasty, traumatic hip dislocation, and endovenous laser ablation for varicose veins. The mean patient age was 73 years, and the preoperative manual muscle test (MMT) grade of the tibialis anterior muscle was 0 in all cases. Nerve transfer was performed at a mean of 6.0 months after injury. A motor fascicle of the tibial nerve containing branches to the soleus or toe flexor muscles was transferred to the motor branch of the tibialis anterior muscle or the deep peroneal nerve using end-to-end neurorrhaphy. At a mean follow-up of 32 months, the MMT grade of the tibialis anterior improved to 3, 3, and 4. All patients were able to walk independently without an ankle–foot orthosis, and no donor nerve deficits were observed. Tibial nerve transfer may represent a useful surgical option for common peroneal nerve palsy.
