To study the long-term utility of transfer of the tibialis anterior tendon to the heel in patients who have a myelomeningocele, we reviewed the cases of twenty-five patients who had reached maturity. Forty-six transfers had been performed in these patients, and all of the patients had been followed for at least twelve years. At follow-up, four of the forty-six transferred muscles were functioning in a foot that was plantigrade, eleven were functioning but the foot had a persistent calcaneal deformity, and seventeen transferred muscles had never functioned. Of the fourteen remaining feet, eight had required a release of the transferred tendon because of progressive equinus deformity after the transfer and six had a minor degree of the same deformity but additional surgical treatment was not deemed necessary for them. Patients who had been operated on after the age of five years generally benefited more from the operation, in that additional surgical procedures were not necessary and the transfer was functional at the time of our review. Most of the patients in whom an equinus deformity developed after the procedure were later found to have spasticity in some of the muscles of the leg. It is likely that these patients originally had unrecognized spasticity in the transferred muscles.