When should I see a podiatrist?

You should see a podiatrist for any persistent foot or ankle pain lasting more than a few days, difficulty walking, numbness or tingling, wounds that won't heal, changes in skin color or temperature, or structural deformities. Dr. Tom Biernacki, DPM is a board-certified podiatrist serving SE Michigan with same-day appointments available. Call 810-206-1402.

Does Dr. Biernacki accept insurance?

Balance Foot & Ankle accepts most major insurance plans including Blue Cross Blue Shield, Aetna, United Healthcare, Cigna, Medicare, and many others. Contact our office at 810-206-1402 to verify your specific coverage. We also offer affordable self-pay options.

What should I expect at my first podiatry appointment?

Your first visit includes a comprehensive evaluation with Dr. Biernacki including medical history review, physical examination, biomechanical assessment, and any necessary diagnostic imaging (X-rays are available in-office). You'll receive a diagnosis, treatment plan, and same-day treatment when possible. Most initial visits take approximately 30-45 minutes.

Extensor Tendonitis | Top of Foot Pain Explained

Name: Extensor Tendonitis | Top of Foot Pain Explained
Creator: Dr. Tom Biernacki, DPM
Published: 2026-03-23T10:04:09-04:00

Medically Reviewed by Dr. Jeffery Agnoli, DPM — Board-Certified Podiatrist, Balance Foot & Ankle Specialists, Michigan. Last updated April 2026.

What Is Extensor Tendonitis of the Foot?

Extensor tendonitis is inflammation of the tendons that run across the top of your foot and help lift the toes and foot upward (dorsiflexion). These tendons — the extensor digitorum longus, extensor hallucis longus, and tibialis anterior — are prone to overuse and irritation, especially in runners, hikers, and people who wear tight shoes.

At Balance Foot & Ankle in Howell and Bloomfield Township, Michigan, we see extensor tendonitis frequently and it’s almost always treatable without surgery.

Symptoms of Extensor Tendonitis

Pain and tenderness across the top of the foot
Swelling along the tendon path
Pain that worsens with activity or when bending the foot upward
Aching after long periods of standing or walking
Occasionally, a creaking sensation (crepitus) with movement

What Causes It?

The most common causes include:

Tight shoe laces or footwear: Compression over the top of the foot is the #1 cause
Sudden increase in activity: Too much mileage too fast
Foot structure: High arches increase tension on extensor tendons
Downhill running: Requires constant eccentric extensor work
Direct trauma: A blow or crush injury to the top of the foot

Extensor Tendonitis vs. Stress Fracture

Both cause top-of-foot pain, but distinguishing them matters for treatment. Stress fractures produce point tenderness over a specific bone, worsen significantly with impact, and may show on X-ray or MRI. Extensor tendonitis pain is more diffuse along the tendon, often accompanied by visible swelling, and is aggravated more by pulling the foot up than stepping down.

When in doubt, imaging rules out fracture — don’t self-diagnose and push through top-of-foot pain.

Treatment Options

Conservative First-Line Care

Activity modification: Reduce or pause aggravating activity for 1–2 weeks
Shoe lace adjustment: Skip the lace row over the tender spot; use looser lacing patterns
Ice: 15–20 minutes after activity to reduce inflammation
NSAIDs: Ibuprofen or naproxen for short-term pain management
Padding: Metatarsal pads or tongue pads redistribute pressure

Physical Therapy

Eccentric strengthening of the anterior tibialis and extensor muscles, combined with calf stretching, reduces tendon load and prevents recurrence. Your podiatrist may refer you to PT for a structured 4–6 week protocol.

Custom Orthotics

For patients with high arches or biomechanical contributors, custom orthotic devices offload the extensor tendons and correct the underlying structural cause.

Corticosteroid Injections

Used selectively when conservative care fails. Unlike heel or plantar fascia injections, extensor tendon injections must be placed carefully to avoid tendon weakening. Your podiatrist will guide this decision.

How Long Does Recovery Take?

Most cases resolve in 4–8 weeks with consistent conservative care. Cases with underlying high arch mechanics or those that have been ignored for months may take longer and benefit from orthotic intervention.

Prevention Tips

Use proper lacing techniques — never overtighten across the instep
Choose footwear with adequate volume in the toe box and across the midfoot
Increase running or hiking mileage no faster than 10% per week
Stretch the calves and anterior tibialis regularly

When to See a Podiatrist

If your top-of-foot pain has lasted more than 2 weeks, is getting worse with rest, or you felt a pop or significant trauma — see a podiatrist promptly. At Balance Foot & Ankle, we’ll perform a thorough biomechanical exam and imaging as needed to confirm the diagnosis and get you better faster.

Foot or Ankle Pain? We Can Help.

Balance Foot & Ankle — Howell & Bloomfield Township, MI

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📞 (810) 206-1402

Dr. Tom Biernacki, DPM

Affiliate Disclosure: This page contains affiliate links to products we recommend. If you purchase through these links, Balance Foot & Ankle may earn a small commission at no additional cost to you. We only recommend products we use with our patients.

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.