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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.
Watch: Dr. Tom Biernacki, DPM
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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The Extensor Tendons of the Foot
The extensor tendons of the foot are responsible for lifting the toes and dorsiflexing the ankle—critical functions for clearing the ground during the swing phase of gait and maintaining foot position during activity. The primary extensor tendons include the extensor hallucis longus (EHL), which extends the great toe; the extensor digitorum longus (EDL), which extends the lesser toes; and the extensor digitorum brevis (EDB), a shorter intrinsic muscle contributing to toe extension. These tendons course across the dorsum (top) of the foot in a relatively superficial position, making them vulnerable to injury from lacerations, crush injuries, and avulsion forces.
Causes of Extensor Tendon Injury
Extensor tendon lacerations most commonly result from sharp object contact (broken glass, metal edges, garden tools, kitchen knives) across the top of the foot or ankle. Motor vehicle accidents—particularly involving motorcycle riders and cyclists whose dorsal foot contacts ground or vehicle components—produce combined laceration and crush injuries. Avulsion injuries occur when excessive plantarflexion force ruptures a tendon from its bony attachment, most commonly the EHL from the distal phalanx of the hallux. Repetitive microtrauma in certain athletes (particularly those who perform frequent forced dorsiflexion) can cause chronic tendinopathy and partial tears of the dorsal tendons.
Diagnosis
Diagnosis is primarily clinical. A laceration across the dorsal foot or ankle with any inability to actively extend the toes or ankle should be assumed to involve tendon injury until proven otherwise. The specific tendon(s) affected are identified by testing active toe extension against examiner resistance for each digit separately. EHL injury produces inability to extend the interphalangeal joint of the great toe. EDL injuries produce toe drop of individual lesser toes. Deep lacerations may also involve deeper structures including the dorsalis pedis artery and deep peroneal nerve, requiring vascular and neurologic assessment. X-ray excludes associated fracture; ultrasound visualizes tendon continuity when clinical assessment is inconclusive.
Surgical Repair
Complete extensor tendon lacerations require surgical repair, ideally within 5–7 days of injury before tendon retraction and adhesion formation complicate the repair. Surgery is performed under ankle block or general anesthesia. The wound is extended as needed to identify and retrieve the proximal and distal tendon ends. A modified Kessler, Bunnell, or running locked suture technique using non-absorbable suture (typically 4-0 or 3-0 braided polyester) reapproximates the tendon ends. When significant tendon tissue is lost, end-to-side repair to an adjacent intact tendon maintains function. The wound is irrigated, closed in layers, and the foot placed in a short leg splint with the ankle in neutral and toes in extension to offload the repair.
Rehabilitation and Recovery
Post-repair immobilization in a splint or cast for 3–4 weeks allows initial tendon healing. A protective dorsal splint maintains toe extension during the subsequent mobilization phase, allowing gentle active range of motion exercises while protecting the repair from excessive tension. Progressive strengthening begins at 6 weeks. Return to footwear and light activity occurs at 6–8 weeks; return to full activity at 10–12 weeks. Physiotherapy addressing scar management, tendon gliding exercises, and strength restoration is important for optimal long-term outcome. Most patients recover full or near-full function following timely, technically sound extensor tendon repair.
Ready to Relieve Your Foot Pain?
Board-certified podiatrists serving Southeast Michigan. Same-week appointments available.
Book Your AppointmentFoot Tendon Injury Treatment in Michigan
Extensor tendon injuries — from lacerations to chronic tendinopathy — affect your ability to lift your toes and walk normally. Dr. Tom Biernacki provides expert surgical repair, splinting, and rehabilitation for all extensor tendon injuries at Balance Foot & Ankle.
Learn About Our Surgical Options | Book Your Appointment | Call (810) 206-1402
Clinical References
- Bade H, et al. “Anatomy of the extensor apparatus of the lesser toes.” Surg Radiol Anat. 1997;19(4):229-232.
- Haddad SL, et al. “Results of flexor-to-extensor and extensor brevis tendon transfer for correction of the crossover second toe deformity.” Foot Ankle Int. 2000;21(7):589-596.
- Kose O. “An overview of foot injuries in sport.” J Orthop Trauma Rehabil. 2014;18(2):68-73.
Insurance Accepted
BCBS · Medicare · Aetna · Cigna · United Healthcare · HAP · Priority Health · Humana · View All →
Howell Office
4330 E Grand River Ave
Howell, MI 48843
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Bloomfield Hills Office
43494 Woodward Ave, Suite 208
Bloomfield Hills, MI 48302
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Same-week appointments available at both locations.
Book Your AppointmentWatch: Extensor Tendon Injuries: Foot Surgical Repair
Dr. Tom on extensor tendon injuries — laceration repair, tendinitis, surgical reconstruction options.
Extensor Tendon Recovery Kit
Post-repair protection + rehab. Dr. Tom’s kit:
As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. This supports our free patient education content.
Limits tendon stress during healing.
Reduces dorsal foot pressure on incision.
Post-op swelling.
Peri-incisional topical relief.
Related: Tendon Transfer · Sports Medicine · Book Same-Week Appointment
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.
Dr. Hoy’s Complete Pain Relief Line — Dr. Tom’s Picks (2026)
Dr. Hoy’s Natural Pain Relief is Dr. Tom Biernacki, DPM’s #1 prescription topical pain relief for plantar fasciitis, Achilles tendonitis, foot pain, knee pain, and back pain. Cleaner formula than Voltaren or Biofreeze — safe for diabetics + daily long-term use without 30-day limits. Below is the complete Dr. Hoy’s product line, organized by use case.
Dr. Hoy’s Natural Pain Relief Gel (4oz Tube)Dr. Tom’s #1 Brand
The flagship Dr. Hoy’s — menthol-based natural pain relief gel. The bottle Dr. Tom hands every plantar fasciitis patient on visit one. Cleaner formula than Voltaren or Biofreeze.
- Menthol-based natural formula
- No greasy residue
- Safe for diabetics
- Fast cooling relief 5-10 min
- Daily long-term use safe
- Pricier than Biofreeze
- Strong menthol scent at first
Top 10 Premade Orthotics — Dr. Tom’s Picks (2026)
Dr. Tom Biernacki, DPM has tested 60+ over-the-counter orthotic insoles in his Michigan podiatry practice over the past 15 years. Below are the top 10 he prescribes most often — ranked by clinical results, build quality, and patient feedback. PowerStep + CURREX brands are Dr. Tom’s #1 prescription brands — built by podiatrists, with biomechanical features (lateral wedge, deep heel cradle, dual-density EVA) that 90% of OTC insoles lack.
Dr. Tom Biernacki, DPM is a board-certified podiatrist + Amazon Associate. Picks shown are products he prescribes to patients at Balance Foot & Ankle Specialists. We earn a commission on qualifying purchases at no extra cost to you. All products independently tested + reviewed. Last verified: April 28, 2026.
PowerStep Pinnacle MaxxDr. Tom’s #1 Brand
The most prescribed OTC orthotic in podiatry. Lateral wedge corrects overpronation that causes 90% of plantar fasciitis. Deep heel cradle stabilizes the ankle.
- Lateral wedge corrects pronation
- Deep heel cradle
- Dual-density EVA
- Trim-to-fit
- Used by 10,000+ podiatrists
- Trim required
- 5-7 day break-in
PowerStep Original Full LengthDr. Tom’s #1 Brand
The original PowerStep — flexible semi-rigid arch with deep heel cradle. The right choice for neutral feet that need everyday support without the lateral wedge.
- Flexible semi-rigid arch
- Deep heel cradle
- Fits dress shoes
- 30-day guarantee
- APMA-accepted
- Less aggressive than Pinnacle
- No lateral wedge for overpronation
PowerStep Pulse MaxxDr. Tom’s #1 Brand
Built for runners + athletes who need maximum support during high-impact activity. Engineered for forefoot strike + lateral motion.
- Sport-specific cushioning
- Lateral wedge for runners
- Antimicrobial top cover
- Shock-absorbing forefoot
- Pricier than Pinnacle
- Best for athletes only
CURREX RunProDr. Tom’s #1 Brand
German-engineered insole with 3 arch heights (Low, Med, High) for custom fit. Carbon-reinforced heel + dynamic forefoot.
- 3 arch heights for custom fit
- Carbon-reinforced heel
- Sport-specific zones
- Premium materials
- Pricier than PowerStep
- 7-10 day break-in
CURREX EdgeProDr. Tom’s #1 Brand
For hikers, skiers, and high-impact athletes — reinforced shank prevents foot fatigue on steep descents + uneven terrain.
- Reinforced shank
- 3 arch heights
- Cold-weather friendly
- Carbon plate
- Stiff feel — not for casual
- Pricier
CURREX SupportSTPDr. Tom’s #1 Brand
For nurses, retail, and standing professions — the most supportive CURREX with deep heel cup + maximum medial support.
- Maximum medial support
- Deep heel cup
- 12-hour shift tested
- Slip-proof
- Stiffest CURREX option
- Pricier
Superfeet Green
Firm, structured arch support — the right choice ONLY for high-arched (cavus) feet. Wrong choice for flat feet.
- Strong structured arch
- Deep heel cup
- Long-lasting (5+ years)
- Firm — not for flat feet
- No lateral wedge
Vionic OrthoHeel Active Insole
APMA-accepted, podiatrist-designed casual insole. Best for adding mild arch support to dress shoes + walking shoes.
- APMA-accepted
- Slim profile
- Antimicrobial top
- Less support than PowerStep
- No lateral wedge
Dr. Tom’s Top 3 — The Premium Foot Pain Stack (2026)
If you only buy three things for foot pain, get these. PowerStep + CURREX orthotics correct the underlying foot mechanics, and Dr. Hoy’s pain gel delivers fast topical relief. This is the exact stack Dr. Tom Biernacki, DPM gives his Michigan podiatry patients on visit one — over 10,000 patients have used this exact combination.
Dr. Tom Biernacki, DPM is a board-certified podiatrist + Amazon Associate. Picks shown are products he prescribes to patients at Balance Foot & Ankle Specialists. We earn a commission on qualifying purchases at no extra cost to you. All products independently tested + reviewed for 30+ days minimum. Last verified: April 28, 2026.
PowerStep Pinnacle MaxxDr. Tom’s #1 Brand
Dr. Tom’s most-prescribed OTC orthotic. Lateral wedge corrects overpronation that causes 90% of foot pain. Deep heel cradle stabilizes the ankle. Built by podiatrists, used by patients worldwide.
- Lateral wedge corrects pronation
- Deep heel cradle stabilizes ankle
- Dual-density EVA — comfort + support
- Trim-to-fit any shoe
- Used by 10,000+ podiatrists
- Trim-to-size required
- 5-7 day break-in for some
CURREX RunProDr. Tom’s #1 Brand
3 arch heights for custom fit (Low/Med/High). Carbon-reinforced heel + dynamic forefoot — the closest OTC orthotic to a $500 custom orthotic. Engineered in Germany.
- 3 arch heights for custom fit
- Carbon-reinforced heel cup
- Dynamic forefoot zone
- Premium German engineering
- Sport-specific support
- Pricier than PowerStep
- 7-10 day break-in
Dr. Hoy’s Natural Pain Relief GelDr. Tom’s #1 Brand
Menthol-based natural pain relief — Dr. Tom’s #1 brand for fast relief without greasy residue. Safe for diabetics + daily use. Cleaner formula than Voltaren or Biofreeze.
- Menthol-based natural formula
- No greasy residue
- Safe for diabetics
- Fast cooling relief — 5-10 minutes
- Cleaner ingredient list than Biofreeze
- Pricier than Biofreeze
- Strong menthol scent at first
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.
Get Expert Care at Balance Foot & Ankle
Same-week appointments at our Howell and Bloomfield Hills offices. Board-certified podiatric surgeons. Most insurance accepted.
Dr. Tom Biernacki, DPM is a board-certified foot & ankle surgeon (ABFAS & ABPM) 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 made him one of the most-followed foot & ankle educators on YouTube.