Quick answer: This page provides evidence-based clinical guidance reviewed by Dr. Tom Biernacki, DPM, board-certified podiatric surgeon at Balance Foot & Ankle in Howell and Bloomfield Hills, MI. Call (810) 206-1402 for same-week appointments.
Extensor hallucis longus (EHL) tendon laceration or avulsion needs repair within the first week to preserve big-toe lift function. Delayed repair leads to permanent weakness and gait changes.
You’re in the right place. Dr. Tom Biernacki, DPM, FACFAS — board-certified foot & ankle surgeon with 3,000+ surgeries — explains exactly what EHL tendon repair means and what works. Call (810) 206-1402 for same-day appointment at Howell or Bloomfield Hills.
Medically reviewed by Dr. Tom Biernacki, DPM · Board-Certified Podiatric Surgeon · Last reviewed: April 2026 · Editorial Policy
Quick Answer
Extensor Hallucis Longus Tendon Repair: Laceration, Avulsion relates to tendon injury — typically caused by overuse or sudden strain. Most patients improve in 6-12 weeks with conservative care. Same-week appointments in Howell + Bloomfield Twp: (810) 206-1402.
Medically reviewed by Dr. Tom Biernacki, DPM — Board-certified foot & ankle surgeon, 3,000+ surgeries performed. Updated April 2026 with current clinical evidence. This article reflects real practice experience from Balance Foot & Ankle Specialists in Howell and Bloomfield Hills, Michigan.
Quick Answer
Most foot and ankle problems respond to conservative care — proper footwear, supportive inserts, activity modification, and targeted stretching — within 4-8 weeks. Persistent pain beyond that window, or any symptom that prevents walking, warrants a podiatric evaluation to rule out fracture, tendon tear, or systemic cause.
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Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.
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Medically Reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatrist, Balance Foot & Ankle Specialists, Michigan. Last updated April 2026.
The extensor hallucis longus (EHL) tendon — running from the anterior compartment of the leg across the dorsal ankle to the distal phalanx of the great toe — is the most commonly lacerated tendon on the dorsal foot, typically from lawnmower injuries, industrial machinery contact, or sharp laceration. EHL tendon injuries require prompt evaluation because retracted tendons, contaminated wounds, and delayed repair significantly worsen outcomes.
Anatomy and Clinical Examination
The EHL runs beneath the superior and inferior extensor retinaculum at the ankle, then continues across the dorsal foot to insert on the dorsal base of the distal phalanx — providing active great toe dorsiflexion. The diagnosis of complete EHL laceration is clinical: inability to actively dorsiflex the great toe against resistance, a palpable tendon defect proximal to the wound (as the proximal stump retracts proximally due to anterior compartment muscle pull), and characteristic drooping of the hallux. Partial lacerations (>50% of the tendon cross-section) should be treated as complete tears to prevent progressive gaping under physiological loads.
Surgical Repair Principles
Acute EHL repair (within 72 hours) through an adequate wound extension provides the most reliable outcomes. The key technical principles: (1) Adequate exposure — the proximal stump retracts under the extensor retinaculum and may require retinaculum incision to retrieve it; (2) Core tendon repair using a modified Kessler or Adelaide suture technique with 3-0 or 4-0 non-absorbable suture; (3) Epitenon repair with running 5-0 absorbable suture to restore gliding surface smoothness; (4) Post-operative immobilization in a toe extension splint or cast for 3–4 weeks, followed by progressive range of motion. In contaminated wounds (lawnmower injuries), delayed primary repair at 48–72 hours after thorough irrigation and debridement is preferable to immediate repair — contaminated primary repair carries high infection and re-tear rates.
EHL Avulsion and Distal Phalanx Fracture
EHL avulsion from the distal phalanx produces a mallet toe deformity of the hallux (flexion deformity of the interphalangeal joint with inability to extend). Bony avulsion (with a small dorsal phalanx fragment) may be treated with splinting in extension if non-displaced; displaced or large fragments require surgical reattachment. Purely ligamentous avulsion without bony fragment is repaired directly to the phalanx through drill holes or suture anchor fixation. Dr. Biernacki at Balance Foot & Ankle performs EHL tendon repair and manages dorsal foot tendon lacerations. Call (810) 206-1402 at our Bloomfield Hills or Howell office for urgent tendon injury evaluation.
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Our board-certified podiatrists treat this condition at two convenient locations. Same-day appointments often available.
When to See a Podiatrist
Many foot conditions can be managed conservatively at home, but some require professional evaluation. See a podiatrist promptly if you experience:
- Pain that persists for more than 2 weeks despite rest
- Swelling, redness, or warmth that isn’t improving
- Numbness, tingling, or burning in the feet
- A wound or sore that is not healing within 2 weeks
- Any foot concern if you have diabetes or poor circulation
- Nail changes that suggest fungal infection or other problems
At Balance Foot & Ankle, our three board-certified podiatrists — Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin — provide comprehensive foot and ankle care at our Howell and Bloomfield Township offices. Most insurance plans are accepted.
Related Conditions & Resources
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Board-certified podiatrists Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients daily at our Howell and Bloomfield Township, MI offices.
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3980 E Grand River Ave, Suite 140
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43700 Woodward Ave, Suite 207
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Same-week appointments available at both locations.
In-Office Treatment at Balance Foot & Ankle
If home care isn’t resolving your your foot or ankle concern, a visit with a board-certified podiatrist is the fastest path to accurate diagnosis and a personalized plan. At Balance Foot & Ankle Specialists, Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin offer same-day and next-day appointments at both our Howell and Bloomfield Hills offices. We perform on-site diagnostic ultrasound, digital X-ray, conservative care, advanced regenerative treatments, and minimally invasive surgery when indicated.
Call (810) 206-1402 or request an appointment online. Most insurance plans accepted, including Medicare, Blue Cross Blue Shield, Aetna, Cigna, and United Healthcare.
Most Common Mistake We See
The most common mistake we see is: Waiting too long before seeking care. Fix: any foot pain lasting more than 4 weeks, or any sudden severe symptom, deserves a professional evaluation rather than more rest.
Warning Signs That Need Same-Day Care
Seek immediate evaluation at Balance Foot & Ankle if you experience any of the following:
- Unable to bear weight
- Severe swelling with skin colour change
- Fever with foot pain (possible infection)
- Diabetes plus any new foot symptom
Call (810) 206-1402 — same-day and next-day appointments at our Howell and Bloomfield Hills offices.
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Podiatrist-recommended products
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Immobilization post EHL tendon repair to protect the reconstruction.
Cold therapy for post-operative swelling after tendon repair.
Topical comfort during post-op tendon recovery.
Post-rehab support when transitioning back to regular shoes.
Related resources
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More Podiatrist-Recommended Foot Health Essentials
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Watch: Heel Bursitis & Achilles Tendon Bursitis [Best HOME Treatment!] — MichiganFootDoctors YouTube
Max-cushion everyday shoe — podiatrist favorite for walking and running.
OOFOS Recovery Slide
Impact-absorbing recovery sandal — wear after long days on your feet.
As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. Product recommendations are based on clinical experience; prices and availability shown above update live from Amazon.
When to See a Podiatrist
If foot or ankle pain has been bothering you for more than a few weeks, home care alone may not be enough. Balance Foot & Ankle offers same-week appointments at our Howell and Bloomfield Hills clinics — no referral needed in most cases. Bring your current shoes and a short list of symptoms and we’ll build you a treatment plan in one visit.
Call Balance Foot & Ankle: (810) 206-1402 · Book online · Offices in Howell & Bloomfield Hills
Pros & Cons of Conservative Care for foot care
Advantages
- ✓ Conservative care first
- ✓ Same-week appointments
- ✓ Multiple insurance accepted
Considerations
- ✗ Self-treatment can mask issues
- ✗ See a podiatrist if pain >2 weeks
Dr. Tom’s Recommended Products for foot care
Affiliate disclosure: As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. We only recommend products we use with patients.
Footnanny Heel Cream Dr. Tom’s Pick
Best for: Daily moisturizer for cracked heels
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About Your Care Team at Balance Foot & Ankle
Dr. Tom Biernacki, DPM · Board-Certified Foot & Ankle Surgeon. Specializes in conservative-first care, minimally invasive bunion surgery, and complex reconstruction.
Dr. Carl Jay, DPM · Accepting new patients. Specializes in sports medicine, athletic injuries, and routine podiatric care.
Dr. Daria Gutkin, DPM, AACFAS · Accepting new patients. Specializes in surgical reconstruction and pediatric podiatry.
Locations: 4330 E Grand River Ave, Howell, MI 48843 · 43494 Woodward Ave Suite 208, Bloomfield Twp, MI 48302
Hours: Mon–Fri 8:00 AM – 5:00 PM · (810) 206-1402
Frequently Asked Questions
When should I see a podiatrist?
If symptoms persist past 2 weeks, affect your normal activity, or are accompanied by red-flag symptoms (warmth, redness, swelling, inability to bear weight).
What does treatment cost?
Most diagnostic visits and conservative treatments are covered by Medicare and major insurers. Out-of-pocket costs vary by your specific plan.
How quickly can I get an appointment?
Most non-urgent cases see us within 5 business days. Urgent cases (sudden pain, possible fracture) typically same or next business day.
Ready for Expert Care?
Same-day appointments in Howell & Bloomfield Hills, MI.
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Or call: (810) 206-1402
Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.
- Plantar Fasciitis: Diagnosis and Conservative Management (PubMed)
- Plantar Fasciitis (APMA)
- Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
- Heel Pain (APMA)