Massage therapy · Kitchener–WaterlooExtensor Tendinopathy of the Foot

Tendinopathy is a general term that covers both tendinosis and tendonitis (Abate et al., 2009). Extensor tendinopathy affects one or more of the tendons that run along the top of your foot. These tendons attach to the muscles that lift your foot and help it clear the ground when you walk. If they become overworked, they can become painful and swollen (NHS Lanarkshire, 2023). Pain is usually felt on the top of the foot and may also be felt at the front of the ankle (NHS Lanarkshire, 2023).

Tendonitis means inflammation of a tendon. Inflammation is the way the body protects itself against damage from stress, infection or injury. Tendinosis refers to a weakening of the tendon: tiny tears form in the tendon tissue and fail to heal, leading to pain and reduced function. In the early stages there may also be some inflammation (Abate et al., 2009). Tendon pain is usually the result of overuse (NHS Lanarkshire, 2023).

Extensor Tendinopathy of the Foot Anatomy

The extensor muscles are on the front of the lower leg and ankle, and their tendons run down along the top of the foot to attach in different areas of the foot (NHS Lanarkshire, 2023). The main ones are the tibialis anterior, which is the main muscle that lifts the ankle (NHS Lanarkshire, 2023), and the extensor digitorum longus and extensor hallucis longus, which lift the toes. When you walk, these muscles lift the foot and toes so they don't catch the ground, and control the foot as it lands (NHS Lanarkshire, 2023).

How to Treat Extensor Tendinopathy of the Foot

Tips

• Wear comfortable shoes and avoid lacing them too tightly, as this puts extra pressure on the top of the foot (NHS Lanarkshire, 2023).
• Tendon injuries take a long time to heal. Most people improve within 3 months, though for some it takes up to a year, so give yourself a proper healing period (NHS Lanarkshire, 2023).
• Degenerative changes in the tendon can be linked to ageing as well as to other factors (Abate et al., 2009).
• Overloading the tendons, such as long periods of standing, walking or running, especially a sudden increase in these activities, can bring on the condition (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).

Pain on the top of the foot usually comes from asking the tendons there to do more than they're ready for, such as a sudden jump in standing, walking or running. My aim is to settle the tendon, take pressure off it, then rebuild its strength gradually so it copes with your normal activities.

I start by assessing how your foot and ankle move, the strength of your calf and the muscles that lift your foot and toes, and how you walk. I'll ask about your shoes, how you lace them and what changed before the pain started, and check sensation.

Calming It Down

• Cutting back the activities that flare it, rather than stopping everything
• Keeping pressure off the sore tendon early on, and working the muscles on the front of the shin and the calf instead
• Warm or cool applications in the clinic, and I'll show you how to use ice safely at home
• Lacing changes and padding so nothing presses on the sore spot
• Short-term taping to offload the tendon, and I'll show you how to tape it yourself

Building It Back

1. NHS Lanarkshire (2023) Extensor tendinopathy. Available at: https://www.nhslanarkshire.scot.nhs.uk/services/physiotherapy-msk/extensor-tendinopathy/ (Accessed: 7 October 2026).
2. Abate, M. et al. (2009) 'Pathogenesis of tendinopathies: inflammation or degeneration?', Arthritis Research & Therapy, 11(3), p. 235. doi: 10.1186/ar2723.
3. 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).