Transfer of the posterior tibial tendon is frequently used for treatment of muscle imbalance, caused by neuromuscula disease or irreparable damage of the common peroneal nerve. The present study evaluates different methods of posterior tibial tendon transfer both biomechanically in respect of the ankle dorsiflexion torque generated and clinical application. Torque measurements for eight cadaver specimens were averaged and plotted as a function of tendon tension. For the average range of motion from 35 degrees plantarflexion up to the neutral position, which reflects an applied force 10 to 30 N on the proximal end of the tendon, positioning sutured to the extensor retinaculum showed a significantly higher torque/force ratio (P<0.05) than the insertion beneath the retinaculum. There were no significant differences for the distal anchoring at the base of the metatarsal III or the os cuneiforme III. Results in 21 patients with positioning of the posterior tibial tendon above the retinaculum showed an improvement of gait in 16 of 18 patients, with excellent, good and satisfactory short-term results in 15 of 18 patients.