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

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.

Foot 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

1. Bade H, et al. “Anatomy of the extensor apparatus of the lesser toes.” Surg Radiol Anat. 1997;19(4):229-232.
2. 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.
3. Kose O. “An overview of foot injuries in sport.” J Orthop Trauma Rehabil. 2014;18(2):68-73.

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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.