Massage therapy · Kitchener–WaterlooExtensor Hallucis Tendinopathy

When the extensor hallucis muscle contracts, it pulls on its tendon. If the strain on the tendon becomes too much, because of a large force or too much repetition, the tendon can be damaged. Overuse causes tiny tears in the tendon which may fail to heal properly (Abate et al., 2009; NHS Lanarkshire, 2023). Tendinopathy is now understood to be mainly a process of wear (degeneration) in the tendon, with some inflammation in the early stages; for this reason the older term 'tendonitis' is now used less (Abate et al., 2009). The extensor hallucis longus muscle and tendon lift the big toe upwards and also help to lift the ankle (Kim et al., 2021). The pain is usually felt on the top of the foot, above the big toe, or at the front of the ankle (NHS Lanarkshire, 2023). Some texts refer to this condition as extensor tendonitis.

Extensor Hallucis Tendinopathy Anatomy

The extensor muscles are on the front of the lower leg, and their tendons run down over the front of the ankle and along the top of the foot (NHS Lanarkshire, 2023). The main ones are the tibialis anterior, which lifts the ankle; the extensor digitorum longus, which lifts the four smaller toes; and the extensor hallucis longus, which lies between these two muscles and attaches to the end of the big toe (Kim et al., 2021; NHS Lanarkshire, 2023). These tendons help to lift the foot and toes so they clear the ground when you walk (NHS Lanarkshire, 2023).

How to Treat Extensor Hallucis Tendinopathy

Tips

• Wear shoes that fit well, and don't tie your laces too tightly. Ill-fitting footwear can increase pressure over the top of the foot (NHS Lanarkshire, 2023).
• A sudden increase in standing, walking or running can bring on the condition (NHS Lanarkshire, 2023).
• Before beginning any exercise routine, take the time to warm up properly.
• Whatever activity you do, use the proper technique and allow enough recovery between sessions to avoid overloading your tendons (NHS Lanarkshire, 2023).
• After an injury, follow a proper rehabilitation programme so the tendon has time to heal. Most people improve within 3 months, though for some it takes up to a year (NHS Lanarkshire, 2023).
• See your family doctor or nurse practitioner if the pain is getting worse, has not improved after 2 weeks of treating it at home, or if you have tingling or loss of feeling in your foot, or diabetes and foot pain (NHS, 2025).

Tendon pain usually comes from asking a tendon to handle more than it's ready for, whether that's a sudden jump in walking or running, or shoes pressing on the top of your foot. My aim is to calm the tendon down, then load it gradually so it gets stronger, while changing whatever has been overloading it.

I start by assessing how your ankle, foot and big toe move, the strength of the muscles at the front of your shin, how you walk, and your footwear and training. I also check the sensation in your foot, since tingling or numbness needs a medical check.

When It's Sore

• Cutting back the activities that flare it, rather than stopping everything
• I mostly leave the sore tendon alone and work the muscles at the front of the shin, plus the calf and foot
• Gentle mobilisation of stiff joints in the ankle and big toe
• Cool applications in the clinic, and I'll show you how to use ice safely at home
• Taping to rest the tendon for a while, and I'll show you how to tape it yourself
• Lacing and footwear changes so nothing presses on the sore spot

As It Settles

1. NHS Lanarkshire (2023) Extensor tendinopathy. Available at: https://www.nhslanarkshire.scot.nhs.uk/services/physiotherapy-msk/extensor-tendinopathy/ (Accessed: 7 October 2026).
2. Kim, W.J. et al. (2021) 'Reconstruction of a neglected, extensor hallucis longus tendon rupture using interposed scar tissue: a case report and literature review', International Journal of Environmental Research and Public Health, 18(22), p. 12157. doi: 10.3390/ijerph182212157.
3. Abate, M. et al. (2009) 'Pathogenesis of tendinopathies: inflammation or degeneration?', Arthritis Research & Therapy, 11(3), p. 235. doi: 10.1186/ar2723.
4. NHS (2025) Pain in the top of the foot. Available at: https://www.nhs.uk/symptoms/foot-pain/pain-in-the-top-of-the-foot/ (Accessed: 7 October 2026).