Massage therapy · Kitchener–WaterlooExtensor Tendon Rupture (Foot)

An extensor tendon rupture is a tear in one of the tendons on the front of the ankle or the top of the foot. These tendons are strong, fibrous cords that connect the muscles at the front of the shin to the foot and toes. A tendon can tear partially or completely. Ruptures of these tendons are rare (Kim et al., 2021; Rodrigues et al., 2013).

The causes depend on which tendon is affected. A tear of the big toe's extensor tendon (extensor hallucis longus) is most often caused by a cut, for example when a sharp object is dropped onto the top of the foot (Kim et al., 2021). The tibialis anterior tendon at the front of the ankle can tear during an injury such as a fall, or can tear on its own (spontaneously), often where the tendon has already worn (Rodrigues et al., 2013).

If you tear a tendon, you may have sudden, severe pain during an accident or activity, and you might hear a popping or snapping sound (NHS, 2023). With a tibialis anterior tear, you may have pain at the front of the ankle, difficulty walking normally, a lump at the front of the ankle, and difficulty lifting the foot (Rodrigues et al., 2013). With a big-toe tendon tear, the big toe may be weak or unable to lift (Kim et al., 2021). Tibialis anterior tears are often diagnosed late because the pain can be mild and other tendons partly take over its job, but an unrecognised tear can lead to lasting problems with movement (Rodrigues et al., 2013).

Extensor Tendon Rupture Anatomy

The extensor muscles are on the front of the lower leg, and their tendons pass over the front of the ankle and along the top of the foot. The tibialis anterior lifts the ankle; the extensor digitorum longus lifts the four smaller toes; and the extensor hallucis longus lies between these two muscles and attaches to the end of the big toe, which it lifts (Kim et al., 2021; Rodrigues et al., 2013).

Treatments you may want to discuss with your family doctor or nurse practitioner

Rehabilitation

Tips

• Tibialis anterior tears that happen on their own are more common in men over 45 and in people who already have wear in the tendon (Rodrigues et al., 2013).
• Conditions that increase the risk of these tendon tears include diabetes, rheumatoid arthritis, gout and long-term steroid treatment (Rodrigues et al., 2013; Kim et al., 2021).
• Steroid injections near the tendon have also been linked with extensor tendon tears (Kim et al., 2021).
• Protect your feet from dropped sharp objects, for example by wearing suitable footwear, as cuts are the most common cause of big-toe tendon tears (Kim et al., 2021).
• Always rehabilitate with your physiotherapist or with me.

After an extensor tendon tear, the tendon needs protecting while it heals, but too long without movement leaves the ankle and toes stiff and the leg weak. Your surgical team decides how long you're in a cast or boot, when you can put weight through the foot and which movements are safe. I work inside those limits, check what you've been cleared for, and need your surgeon's okay before we start any hands-on treatment. Bring your operative notes or rehab guidelines if you have them, and I'm happy to check in with your team.

I start by assessing how your ankle, foot and toes move, your leg strength and how you walk, within what your team allows.

Acute: New

Subacute: Healing

Chronic: Persisting

1. 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.
2. Rodrigues, M.E. et al. (2013) 'Traumatic rupture of the tibialis anterior tendon: a case report', Revista Brasileira de Ortopedia, 48(3), pp. 278-281. doi: 10.1016/j.rboe.2012.08.004.
3. NHS (2023) Tendonitis. Available at: https://www.nhs.uk/conditions/tendonitis/ (Accessed: 8 October 2026).