Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

Extensor tendon injuries of the foot — lacerations, avulsions, or attrition tears of the tendons responsible for dorsiflexing the toes and foot — are common injuries that require systematic evaluation and appropriate repair to prevent permanent toe drop deformity. Because the extensor tendons on the dorsal foot lie immediately beneath thin skin with minimal subcutaneous protection, they are vulnerable to even superficial lacerations, and apparently minor dorsal foot wounds may involve complete extensor tendon disruption.

Extensor Tendon Anatomy

Dorsal foot extensor tendons: the extensor digitorum longus (EDL) sends four slips to toes 2–5, joined at the MTP joint by the extensor digitorum brevis (EDB) from the dorsal calcaneus; the extensor hallucis longus (EHL) inserts into the distal phalanx of the hallux; the extensor hallucis brevis (EHB) inserts at the proximal phalanx. Extensor mechanism: at each MTP joint, the extensor hood mechanism redistributes extensor force to the proximal and distal phalanges via the dorsal apparatus — disruption produces MTP joint plantar flexion (toe drop) and hyperextension contracture of the interphalangeal joints (intrinsic-minus toe deformity). Zones of injury: Zone I (over the distal phalanx — mallet toe equivalent); Zone II (over the middle phalanx); Zone III (over the proximal phalanx); Zone IV (over the MTP joint — extensor hood injury); Zone V (over the metatarsal shaft); Zone VI (at the ankle and dorsal foot); Zones VII–VIII (proximal). Assessment: active toe extension test — the patient attempts to dorsiflex each toe against resistance; inability to extend the MTP or IP joint identifies the injured zone; probe the wound to assess tendon integrity directly under adequate anesthesia and lighting.

Treatment

Zone I–IV injuries (distal to MTP joint): primary repair with 4-0 non-absorbable suture (figure-of-eight or horizontal mattress technique); the flat extensor tendons require careful repair to restore dorsal tension and prevent bowstringing; splint in extension for 4–6 weeks; MTP joint injuries (Zone IV) require repair of the extensor hood to prevent toe drift. Zone V–VIII injuries: primary repair with 3-0 or 4-0 suture (tubular tendon structure in the leg); end-to-end repair; dorsal splint in slight extension for 4–6 weeks; EHL lacerations require meticulous repair to prevent hallux drop affecting push-off power. Neglected injuries: secondary reconstruction with tendon transfer or grafting for lacerations presenting late; EHL rupture managed with EHB transfer. Dr. Biernacki at Balance Foot & Ankle evaluates and repairs extensor tendon injuries of the foot and ankle, including acute lacerations and chronic toe drop deformities. Call (810) 206-1402 at our Bloomfield Hills or Howell office.

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Frequently Asked Questions

When should I see a podiatrist?

See a podiatrist for any foot or ankle pain that persists more than 2 weeks, doesn’t improve with rest, limits your daily activities, or is accompanied by swelling, numbness, or skin changes. People with diabetes or circulation problems should see a podiatrist regularly even without symptoms.

What does a podiatrist treat?

Podiatrists diagnose and treat all conditions of the foot, ankle, and lower leg including plantar fasciitis, bunions, hammertoes, toenail problems, heel pain, nerve pain, diabetic foot care, sports injuries, fractures, and foot deformities — both surgically and non-surgically.

What can I expect at my first podiatry visit?

Your first visit includes a full medical history, physical examination of your feet and gait, and in-office diagnostic imaging if needed (X-rays, ultrasound). We’ll discuss your diagnosis and create a personalized treatment plan. Most visits take 30–45 minutes.

Need Treatment at Balance Foot & Ankle?

Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients at our Howell and Bloomfield Township offices.

Book Online or call (810) 206-1402

Foot Tendon Laceration Repair in Michigan

Extensor tendon injuries on top of the foot from lacerations or crush injuries require prompt surgical repair to restore toe function. Our podiatric surgeons have extensive experience with primary tendon repair and reconstruction of the foot’s dorsal tendons.

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Clinical References

1. Heckman JD, Levine MI. Traumatic closed transection of the tibialis anterior tendon. J Bone Joint Surg Am. 1980;62(7):1163-1167.
2. Markarian GG, Kelikian AS, Brage M, et al. Anterior tibialis tendon ruptures: an outcome analysis of operative versus nonoperative treatment. Foot Ankle Int. 1998;19(12):792-802.
3. Anzel SH, Covey KW, Weiner AD, Lipscomb PR. Disruption of muscles and tendons: an analysis of 1,014 cases. Surgery. 1959;45(3):406-414.

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Dr. Carl Jay, DPM

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Dr. Tom Biernacki, DPM

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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.