Quick answer: Extensor Tendonitis Top Of Foot Michigan is a common foot/ankle topic that affects many patients. The 2026 evidence-based approach combines proper diagnosis, conservative-first treatment, and escalation only when needed. We treat this regularly at our Howell and Bloomfield Township practices. Call (810) 206-1402.
Medically reviewed by Dr. Tom Biernacki, DPM · Board-Certified Podiatric Surgeon · Last reviewed: April 2026 · Editorial Policy
Quick Answer
Extensor Tendonitis — Pain on Top of Foot: Causes  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 Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.
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Pain on the top of the foot is one of the most common chief complaints in our podiatric offices — and extensor tendonitis is among the leading causes, frequently misidentified as a stress fracture, ganglion cyst, or “just shoe pressure.” The extensor tendons run across the dorsum (top) of the foot to extend the toes, and their thin tendon sheaths are highly susceptible to irritation from overuse, tight shoe lacing, and sudden increases in running or walking volume. Dr. Tom Biernacki, DPM at Balance Foot & Ankle in Howell and Bloomfield Hills, Michigan diagnoses and treats extensor tendonitis and differentiates it from other causes of dorsal foot pain.
What Is Extensor Tendonitis?
Extensor tendonitis is inflammation of one or more of the extensor tendons that cross the dorsum of the foot and extend into the toes. The primary tendons involved are the extensor digitorum longus (extends the four lesser toes), the extensor hallucis longus (extends the big toe), and occasionally the extensor digitorum brevis (the short muscle belly visible on the outer dorsum of the foot, sometimes mistaken for a cyst). The tendons pass under the extensor retinaculum at the ankle before spreading across the foot — this retinaculum is a point of friction and compression particularly vulnerable to irritation.
Extensor tendonitis presents as aching or burning pain along the top of the foot — running from the midfoot toward the toes or back toward the ankle. The pain is worse with shoe-wearing (especially tight athletic shoes or boots), with uphill walking or running (which increases dorsiflexion and extensor tendon loading), and at the beginning of activity after rest. The top of the foot may be tender to palpation along the tendon line, and there may be mild soft tissue swelling visible along the tendon path.
Common Causes of Extensor Tendonitis
Tight shoe lacing is the most common and most overlooked cause. A shoe tied tightly across the midfoot compresses the extensor tendons and their sheaths directly. This is particularly common in runners who lace their shoes for maximum security or in hikers wearing stiff boots. The fix is immediately straightforward: retie the shoe using the heel-lock lacing technique (runner’s loop), skip the middle lace eyelets over the sensitive area, or loosen the laces across the instep.
Sudden increase in training volume — adding mileage too quickly, resuming running after a break, or starting a new physical job that involves prolonged walking — is the second most common cause. The extensor tendons adapt slowly to increased load. A 20–30% increase in weekly mileage is generally the safe maximum for preventing overuse injuries including extensor tendonitis.
High-arched (cavus) foot places the extensor tendons under increased tension and creates higher-pressure contact points across the dorsum of the foot with shoe uppers. Custom orthotics that reduce the cavus loading pattern frequently resolve recurrent extensor tendonitis in patients with this foot type.
Equinus deformity — restricted ankle dorsiflexion from tight calf muscles or a shortened Achilles tendon — forces the extensor tendons to work harder to achieve adequate toe clearance during the swing phase of gait. Gastrocnemius stretching and Achilles flexibility work are part of the treatment protocol for extensor tendonitis in patients with equinus.
Differential Diagnosis: Other Causes of Top-of-Foot Pain
Extensor tendonitis must be differentiated from metatarsal stress fracture (point tender over a specific metatarsal shaft, worse with direct pressure or axial load test, X-ray or MRI may show fracture line or marrow edema), dorsal midfoot ganglion cyst (soft, transilluminates, not tender along tendon line), midfoot osteoarthritis (worse with prolonged standing, visible on X-ray as joint space narrowing), and dorsal exostosis / bone spur (bony bump visible on X-ray, tender directly over the prominence). We perform in-office ultrasound to assess tendon integrity and differentiate tendinopathy from a fluid-filled cyst on the same visit.
Treatment for Extensor Tendonitis
Initial treatment focuses on eliminating the provocative mechanical factor. For shoe-related extensor tendonitis, lacing modification, a shoe with a more accommodating upper, or switching from a tight lace pattern to a velcro or strap system often resolves symptoms within 1–2 weeks. Activity modification — reducing uphill running, reducing total mileage — is essential during the acute phase.
Ice application for 15–20 minutes after activity reduces acute inflammation. NSAID medications can be used for 7–10 days during acute flares. Kinesiology taping of the extensor tendons reduces friction and provides proprioceptive feedback — we demonstrate specific taping protocols in our office. For persistent cases, a period of relative rest in a walking boot for 2–3 weeks allows the tendon sheath inflammation to resolve completely before return to activity.
Ultrasound-guided cortisone injection directly into the extensor tendon sheath provides rapid relief for stubborn cases — the tendon sheath, unlike the tendon itself, can receive cortisone safely. MLS laser therapy has been beneficial for accelerating tendon healing in extensor tendonitis in our clinical experience. Custom orthotics address the underlying biomechanical contributors (cavus foot, overpronation) for patients with recurrent presentations.
The Most Common Mistake with Extensor Tendonitis
The most common mistake: continuing to run through the pain while simply loosening the laces slightly. A modest lace adjustment helps but does not address the underlying tendon inflammation. Until the acute inflammatory phase has resolved (typically 1–2 weeks of reduced activity), the tendon sheath cannot heal. Runners who continue training at the same volume during active extensor tendonitis typically convert an acute 2-week condition into a 2–3 month chronic tendinopathy.
Warning Signs — See a Podiatrist
Seek evaluation if: pain is present with rest, not just activity; there is a palpable lump or nodule along the tendon line (may indicate a tendon tear or ganglion); pain does not improve with shoe lacing changes and 1 week of activity reduction; or you are a runner with a sudden increase in pain level (rule out stress fracture, which requires imaging).
Book an Evaluation — Howell & Bloomfield Hills
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Dr. Tom Biernacki, DPM performs same-day X-ray and in-office diagnostic ultrasound for top-of-foot pain evaluation at both Balance Foot & Ankle locations. Call (810) 206-1402 or book online. Serving Howell, Brighton, Bloomfield Hills, Troy, and all of southeastern Michigan.
Related: Metatarsal Fracture · Ganglion Cyst Foot & Ankle · Custom Orthotics Michigan
Dr. Tom’s Recommended Products for Achilles Tendon Pain
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Our board-certified podiatrists treat this condition at two convenient locations. Same-day appointments often available.
These are products I personally use and recommend to my patients at Balance Foot & Ankle.
- Aircast AirHeel Ankle Brace — Pneumatic cells pulse with each step to reduce Achilles tendon load and promote blood flow for healing
- Doctor Hoy’s Natural Pain Relief Gel 3oz — Arnica + camphor formula — apply 3-4x daily to the painful area for natural topical relief
- PowerStep Pinnacle Plus Insoles (Heel Lift) — Elevated heel reduces Achilles tensile load with each step — immediate pain reduction for insertional tendonitis
Affiliate disclosure: As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. We only recommend products we trust for our own patients.
Dr. Tom’s Recommended: Natural Topical Pain Relief
This is what I actually use in our clinic at Balance Foot & Ankle.
- Doctor Hoy’s Natural Pain Relief Gel — Natural topical pain relief I use in our clinic. Arnica + camphor formula. Apply directly to the painful area 3-4x daily for fast-acting relief without NSAIDs.
Affiliate disclosure: As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. We only recommend products we trust for our own patients.
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Dr. Biernacki and our team at Balance Foot & Ankle are accepting new patients in Howell and Bloomfield Hills, MI. Most insurances accepted.
or call (810) 206-1402
Recommended Products for Achilles Tendonitis
- Strassburg Sock Night Splint — Overnight Achilles Stretch
- Heel Lift Wedge Inserts — Reduce Achilles Tension
- Percussion Massager — Calf & Achilles Recovery
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Expert Tendonitis Treatment in Michigan
Extensor tendonitis on the top of your foot can be debilitating. Our podiatrists identify the cause and provide effective treatment to reduce inflammation and prevent recurrence.
See Our Tendon Treatment Options → | Book Your Appointment | Call (810) 206-1402
Clinical References
- Alfredson H, Lorentzon R. “Chronic tendon pain: no signs of chemical inflammation but high concentrations of the neurotransmitter glutamate.” British Journal of Sports Medicine. 2002;36(3):173-177.
- Khan KM, Cook JL, et al. “Histopathology of common tendinopathies: update and implications for clinical management.” Sports Medicine. 1999;27(6):393-408.
- Lopez RGL, Jung HG. “Tendon problems of the foot and ankle: diagnosis and treatment.” Foot and Ankle International. 2015;36(8):921-929.
Insurance Accepted
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Howell Office
3980 E Grand River Ave, Suite 140
Howell, MI 48843
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Bloomfield Hills Office
43700 Woodward Ave, Suite 207
Bloomfield Hills, MI 48302
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Same-week appointments available at both locations.
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Hoka Clifton 10
Watch: Achilles Tendonitis & Back of Heel Pain [BEST Home Treatments 2024!] — 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.
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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
Watch: Dr. Tom explains
Podiatrist-recommended products
As an Amazon Associate, Dr. Tom earns from qualifying purchases.
Unload the top-of-foot tendons by correcting arch collapse.
View on Amazon →Ice the dorsum after activity to calm tendon inflammation.
View on Amazon →Topical menthol for dorsal tendon pain without oral NSAIDs.
View on Amazon →Stubborn cases benefit from 1-2 weeks of immobilization.
View on Amazon →Related resources
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Same-week appointments · Howell & Bloomfield Hills · 4.9★ (1,123+ reviews)
☎ (810) 206-1402Book Online →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
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
Dr. Hoy’s Natural Pain Relief Gel (8oz Pump Bottle)Dr. Tom’s #1 Brand
8oz pump bottle — same formula as the 4oz tube but 2x the value. Best for athletes, families, or chronic pain patients who use it daily.
- 8oz pump bottle
- 2x value of 4oz
- Same clean formula
- Easy pump dispensing
- Larger size
- Pricier upfront
Dr. Hoy’s Arnica Boost Pain ReliefDr. Tom’s #1 Brand
Dr. Hoy’s + arnica boost — for bruising, swelling, post-injury inflammation. Adds arnica’s anti-inflammatory power to the standard menthol formula.
- Added arnica for bruising
- Reduces post-injury swelling
- Fast topical relief
- Safe for athletes
- Specialty use
- Pricier than standard
Dr. Hoy’s Natural Pain Relief Roll-OnDr. Tom’s #1 Brand
Same Dr. Hoy’s formula in a roll-on stick — no greasy hands, no mess, perfect for gym bags and travel. TSA-friendly.
- No greasy hands
- TSA-friendly
- Travel-sized
- Same Dr. Hoy’s formula
- Less product per use
- Pricier per oz
Dr. Hoy’s Pain Relief Gel — 3-Pack BundleDr. Tom’s #1 Brand
3-pack of Dr. Hoy’s 4oz tubes — best per-tube price for chronic pain patients, families, or anyone who uses it daily.
- 3-pack bulk pricing
- Same flagship formula
- Stockpile value
- Family-sized
- Larger upfront cost
- Need storage space
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
PowerStep Pinnacle
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
Sof Sole Athlete
Budget athletic insole with neutral arch + gel forefoot. Decent value if you need a quick replacement.
- Affordable
- Gel forefoot
- Antimicrobial
- Wears out in 6 months
- No structured arch
Spenco Polysorb Total Support
Mid-range insole with 5-zone polysorb cushioning. Decent support for standing professions.
- 5-zone cushioning
- Trim-to-fit
- Mid-price point
- Less stable 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.
What is Tendonitis?
Tendonitis is a common foot/ankle condition that affects mobility and quality of life. Understanding the underlying cause is the first step in successful treatment. Our podiatrists at Balance Foot & Ankle perform a hands-on biomechanical exam, review your activity history, and use diagnostic imaging when appropriate to identify the root cause—not just treat the symptom. Many patients have been told to “rest and ice” without a deeper diagnostic workup; our approach is different.
Symptoms and warning signs
Common signs of tendonitis include pain that worsens with activity, morning stiffness, swelling, tenderness when palpated, and difficulty bearing weight. If you experience sudden severe pain, inability to walk, visible deformity, numbness or color change, contact our office the same day or visit urgent care—these can signal a more serious injury such as a fracture, tendon rupture, or vascular compromise. Diabetics with any foot wound should seek same-day care.
Conservative treatment options
Most cases of tendonitis respond to non-surgical care: structured rest, supportive footwear changes, custom orthotics, targeted stretching and strengthening protocols, anti-inflammatory medications when medically appropriate, and in-office procedures such as ultrasound-guided injections. We also offer advanced therapies including MLS laser therapy, EPAT/shockwave, regenerative injections, and image-guided procedures. Treatment is sequenced from least invasive to most invasive, and we explain the rationale at every step.
When is surgery considered?
Surgery is reserved for cases that fail 3-6 months of well-structured conservative care, when there is structural pathology (severe deformity, complete tear, advanced arthritis), or when imaging shows damage that will not heal without intervention. Our surgeons have performed 3,000+ foot and ankle procedures and prioritize minimally-invasive techniques whenever appropriate. We discuss recovery timelines, return-to-activity milestones, and realistic outcome expectations before any procedure is scheduled.
Recovery timeline and prevention
Recovery from tendonitis varies based on severity and chosen treatment path. Conservative cases often improve within 4-8 weeks with consistent adherence to the protocol. Post-procedural recovery may range from a few days (in-office procedures) to several months (reconstructive surgery). Long-term prevention involves footwear assessment, activity modification, structured strengthening, and regular check-ins with your podiatrist if you have a history of recurrence. We provide written home-exercise plans and digital follow-up support.
Ready to feel better?
Same-week appointments available in Howell and Bloomfield Hills, Michigan.
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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.
- Plantar Fasciitis: Diagnosis and Conservative Management (PubMed)
- Plantar Fasciitis (APMA)
- Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
- Heel Pain (APMA)