All About Extensor Tendonitis: Causes, Symptoms, and Treatment

Written by Erica Halpern on October 30, 2025

Medically reviewed by Private: Sarah Higgins, D. Ch.

Extensor tendonitis is a common foot condition that affects the tendons running along the top of your foot. These tendons connect your muscles to your toes and help lift your toes and foot during walking and other activities. When these tendons become inflamed or irritated, it can lead to pain and difficulty moving your foot comfortably.

What Is Extensor Tendonitis?

Extensor tendonitis refers to inflammation or irritation of the extensor tendons on the top of the foot. This condition often results from overuse, repetitive strain, or injury. People who are active in sports, wear tight footwear, or have certain foot structures may be more prone to developing extensor tendonitis.

Causes of Extensor Tendonitis

Overuse: Repetitive activities such as running, jumping, or walking long distances.
Improper Footwear: Shoes that are too tight or have insufficient space on the top can compress the tendons.
Foot Mechanics: Flat feet, high arches, or gait abnormalities can put extra strain on the tendons.
Injury: Trauma or sudden impact to the foot.
Underlying Conditions: Arthritis or inflammatory diseases may contribute to tendon irritation.

Symptoms of Extensor Tendonitis

Pain and tenderness on the top of the foot, especially over the affected tendon.
Swelling or redness along the top of the foot.
Difficulty lifting the toes or foot.
Pain worsens with activity and improves with rest.
Occasionally, a burning or tingling sensation.

Treatment Options

Rest and Activity Modification

Avoid activities that aggravate the pain and allow the tendon to heal.

Proper Footwear

Wear shoes with adequate space in the toe box and good support to reduce pressure on the top of the foot.

Ice Therapy

Apply ice packs to reduce inflammation and pain.

Physical Therapy

Stretching and strengthening exercises can improve tendon flexibility and foot mechanics.

Orthotics

Custom orthotics may help correct biomechanical issues that are causing excess strain on the extensor tendon and muscles on top of the foot.

Medication

Non-steroidal anti-inflammatory drugs (NSAIDs) can reduce pain and inflammation.

When to See a Specialist

If pain persists beyond a few weeks or worsens, consult a chiropodist or foot specialist for a biomechanical assessment and personalized treatment plan.

Do you have pain on the top of your foot?

If you’re experiencing persistent pain on the top of your foot, don’t wait. Schedule an appointment with Feet First Clinic today for expert diagnosis and treatment of extensor tendonitis.

About Author: Erica Halpern

Erica is the operations manager at Feet First Clinic. Since 2021, she has been writing, researching and editing website and social media content. She also oversees Feet First Clinic’s daily and strategic operations to ensure the best possible experience for our clients. Her goal is to ensure patients are equipped with the knowledge and solutions they need to help with their pain.

Learn more about Erica Halpern

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October 2, 2025

Achilles Tendonitis vs Achilles Tendinosis: Understanding Differences, Symptoms, and Treatments

The Achilles tendon is the strongest tendon in the body. It connects your calf muscles to your heel bone and enables activities like walking, running, and jumping. However, it is also prone to injury -particularly from overuse. Two common conditions affecting the Achilles tendon are Achilles tendonitis and Achilles tendinosis. Although their names sound similar, they differ in causes, symptoms, and treatment approaches. Understanding these differences is crucial for effective recovery and prevention. What Is Achilles Tendonitis? Achilles tendonitis is an acute inflammation of the Achilles tendon, typically caused by sudden increased activity or repetitive strain. It results in swelling, pain, and irritation along the tendon. Typical pain in a male jogger`s achilles tendon. XXL size image. Causes of Achilles Tendonitis: Sudden increase in physical activity or intensity Overuse during running or jumping sports Poor footwear Training on hard surfaces Tight calf muscles Poor biomechanics Symptoms of Achilles Tendonitis: Sharp or burning pain along the back of the heel or lower calf Swelling and tenderness over the tendon Stiffness, especially in the morning or after rest Pain worsens with activity What Is Achilles Tendinosis? Achilles tendinosis is a chronic condition characterized by degeneration of the tendon’s collagen fibers without significant inflammation. It often develops after untreated or recurrent Achilles tendonitis and results in thickening and weakening of the tendon. It's essentially what can happen if Achilles tendonitis goes untreated. Causes of Achilles Tendinosis: Repeated micro-tears and poor healing Chronic overuse without adequate rest Aging and reduced blood supply to the tendon Biomechanical abnormalities Symptoms of Achilles Tendinosis: Dull, persistent pain along the tendon Thickened or nodular tendon Decreased strength and flexibility in the calf and ankle Pain may improve with warm-up but worsen with prolonged activity Key Differences Between Tendonitis and Tendinosis FeatureAchilles TendonitisAchilles TendInosisNatureInflammatoryDegenerative (non-inflammatory)DurationAcute or subacuteChronic, long-termTissue ConditionInflamed tendon fibersDegenerated, disorganized fibersPainSharp, localizedDull, diffuseTreatment FocusReduce inflammation, restPromote tendon healing, strengthen Treatment Options For Achilles Tendonitis: Rest and activity modification Ice and anti-inflammatory medications Physical therapy focusing on stretching and strengthening Proper footwear and orthotics Gradual return to activity For Achilles Tendinosis: Eccentric strengthening exercises to stimulate tendon repair Physical therapy and stretching Shockwave therapy or ultrasound treatments Possible use of platelet-rich plasma (PRP) injections Surgery in severe, unresponsive cases Prevention Tips Warm up properly before exercise Gradually increase activity intensity and duration Wear supportive, well-fitting shoes Maintain calf flexibility and strength Avoid running on hard or uneven surfaces when possible

July 10, 2025

What’s the Difference Between an Ankle Foot Orthotic and a Regular Orthotic?

What is an Ankle Foot Orthotic (AFO)? An ankle foot orthotic (AFO) is a medical-grade brace that supports the foot and ankle. It often extends partway up the calf. Unlike regular foot orthotics—which fit inside shoes to support the arch and heel. AFOs offer external stabilization of both the foot and ankle joints. AFOs are commonly made of lightweight plastic or carbon fiber and may be custom-made or prefabricated. They assist walking, correct alignment, reduce pain, and help prevent further injury. Who Needs an AFO? Image from https://braceworks.ca/ and the Washington Post AFO's received mainstream attention a few years ago when NFL quarterback Alex Smith returned to the football field after a catastrophic leg injury. The key to his return: an ankle foot orthotic. Due to a post-surgical infection, the nerve that helps flex the right foot was severed. This meant he couldn't lift his foot. So he got an AFO to help and made a brief comeback (with the help of an extensive rehab team). So who exactly needs an AFO? Since AFOs are heftier than regular orthotics, they're typically recommended for patients with more complex conditions than those addressed by traditional foot orthotics. You might benefit from an AFO brace if you have: Foot drop (difficulty lifting the front of the foot) Cerebral palsy or neuromuscular disorders Stroke-related gait issues Multiple sclerosis (MS) Post-surgical ankle instability Tendon or ligament injuries Severe arthritis affecting ankle mechanics Ankle foot orthotics are most commonly indicated for neuromuscular disorders and foot drop. AFOs v Regular Orthotics: What's the Difference? FeatureRegular OrthoticsAnkle Foot Orthotics (AFOs)ScopeFoot support onlyFoot and ankle supportPlacementInside the shoe (underneath the foot)Worn underneath and around the foot, and around the ankleConditions TreatedArch pain, plantar fasciitis, overpronation, high arches, other biomechanical irregularitiesNeurological and structural gait disorders, severe instabilityCustomizationOften custom-fit or prefabOften custom-molded to leg shapeMobility SupportModerateHigh—can aid in walking and balance While regular orthotics focus on redistributing pressure and correcting foot mechanics inside the shoe, AFOs provide external control for more complex biomechanical or neurological issues. Think of it as the difference between cushioning a sore spot and physically guiding your limb’s motion. How Are AFOs Made and Fitted? https://www.youtube.com/watch?v=nA_QklH7AWY AFOs are usually prescribed by a foot specialist or chiropodist after a full assessment. The process may include: Biomechanical Assessment Gait analysis Casting or 3D scanning Custom fabrication Fitting and adjustments Some patients may only need short-term use post-injury or surgery, while others may rely on AFOs for long-term mobility support. Final Thoughts If you’ve been told you need more than just arch support or if your walking pattern has changed due to injury or illness, an ankle foot orthotic could be a game-changer. At our clinic, we assess your full biomechanics and work with you to find the right support—whether that’s a custom orthotic, AFO, or a combination of both.

June 12, 2025

Morning Routine for Foot Health, Longevity and Mobility

When we talk about healthy habits, we often focus on nutrition, mental health, or overall fitness. But what about your feet? These often-overlooked heroes carry you through life and they deserve some attention, too. Incorporating a few gentle foot mobility drills into your morning routine can help improve flexibility, reduce stiffness, and set you up for a pain-free day. Let’s explore a few simple daily foot exercises that support longevity and mobility, all in under 10 minutes. Why Morning Foot Rituals Matter After a night of rest, it’s normal for your feet to feel stiff or tight. That’s because circulation slows down when we sleep, and our muscles and joints aren’t being used. A quick morning routine for foot health helps: Improve blood flow Gently wake up foot muscles Prevent long-term issues like plantar fasciitis or joint stiffness Support better balance and stability throughout the day Plus, it feels great — and your feet will thank you! Your 5-Minute Morning Routine for Foot Health These beginner-friendly exercises can be done from your bed, the bathroom counter, or even while you’re waiting for your coffee to brew. 1. Toe Spreads (1 minute) https://youtube.com/shorts/gOwgyrmU6hM?feature=shared Sit or stand comfortably. Spread your toes apart as wide as you can, then release. Repeat 10–15 times.Why it helps: Improves foot strength and activates the smaller intrinsic foot muscles that support balance. 2. Ankle Circles (1 minute per foot) https://youtu.be/qaatVpZy2ek?feature=shared Lift one foot off the ground and gently rotate your ankle clockwise 10 times, then counter-clockwise 10 times. Switch feet.Why it helps: Promotes circulation and joint mobility to counteract morning stiffness. 3. Towel Curls (1–2 minutes) https://youtu.be/toqnSys_JRw?feature=shared Place a small towel on the floor and try to scrunch it toward you using just your toes.Why it helps: Strengthens the arches and enhances coordination in the foot muscles. 4. Calf Stretch with Wall or Step (1–2 minutes) https://youtu.be/utLavyPDnqI?feature=shared Stand with your hands on a wall or place your toes on a step while your heel stays on the ground. Lean forward until you feel a stretch in your calf and Achilles tendon. Hold for 20–30 seconds per leg.Why it helps: Loosens up the back of the leg and heel — essential for preventing plantar fasciitis and Achilles tendonitis. Bonus: Gentle Foot Massage https://youtu.be/BwhGFoHDkUI?feature=shared Before putting on your socks or shoes, use your thumbs or a massage ball to roll out the soles of your feet. Focus on tight spots in the arch and heel. Just 1–2 minutes can make a big difference. Foot Mobility Drills = Long-Term Foot Wellness Incorporating these foot mobility drills into your morning can support not just your feet, but your entire body. Improved foot function leads to better posture, less knee and hip pain, and more stability with every step you take. And remember — consistency is key. Like any good habit, the benefits of daily foot exercises build up over time. Feature Photo by Aljona Ovtšinnikova

May 29, 2025

Can Dehydration Cause Foot Pain? Surprising Ways Water Intake Affects Your Feet

When you think of dehydration, you probably imagine symptoms like dry mouth, fatigue, or dizziness, but what about your feet? It may surprise you to learn that dehydration can directly contribute to foot pain, cramping, and even swelling. Since your feet are at the farthest point from your heart, they rely heavily on healthy circulation and fluid balance to function properly. Let’s take a look at how your water intake affects your fee and why staying hydrated is more important than you might think. 1. Dehydration and Foot Cramps If you’ve ever woken up in the middle of the night with a painful foot cramp, dehydration might be the culprit. Proper hydration is essential for normal muscle function. Without enough fluids, your muscle (especially in your feet and calves) can tighten up unexpectedly. Cramps often occur when your body is low on essential electrolytes like potassium, magnesium, and sodium, which are lost through sweat. Since water helps regulate these minerals, not drinking enough can increase your risk of sudden, painful cramps in the feet. 2. Hydration Supports Circulation in the Feet Good circulation is critical for healthy feet. Water plays a major role in keeping your blood flowing efficiently. When you’re dehydrated, your blood volume decreases, making it harder for your heart to pump blood to the extremities—including your feet. Poor circulation can lead to sensations of numbness, tingling, or a “pins and needles” feeling in your feet. In more severe cases, chronic dehydration could contribute to long-term circulatory problems that make foot pain worse over time. 3. Water Helps Lubricate Joints and Reduce Pain Your feet contain more than 30 joints, all of which rely on synovial fluid for smooth, pain-free movement. Dehydration reduces your body’s ability to produce this fluid, leading to stiff, achy joints—especially in people with arthritis or other joint conditions. Drinking enough water each day can help reduce joint discomfort and improve mobility in your feet and ankles. 4. Is Water Retention the Opposite Problem? Interestingly, dehydration can also lead to swollen feet—but not for the reason you might think. When your body senses it's not getting enough water, it holds onto the fluids it does have. This can result in swelling (also known as water retention) in the feet, ankles, and lower legs. Staying properly hydrated signals your body that it can safely release excess fluids, helping to reduce swelling and bloating in the feet. 5. Tips to Keep Your Feet (and the Rest of You) Hydrated Aim for 8–10 glasses of water per day, and more if you're physically active or it's hot outside. Avoid too much caffeine or alcohol, as these can dehydrate your body. Eat water-rich foods like cucumbers, oranges, and watermelon. Listen to your body—if you're feeling thirsty, you're likely already slightly dehydrated. When to Seek Help If you’re experiencing regular foot pain, cramping, or swelling—especially if increasing your water intake doesn’t help—it’s time to speak with a foot care specialist. At Feet First Clinic, our chiropodists can assess the cause of your symptoms and recommend personalized treatment options to get you back on your feet comfortably. Final Thoughts Dehydration doesn’t just leave you feeling tired—it can seriously impact your foot health. From muscle cramps to water retention, the way you hydrate has a direct effect on how your feet feel and function. So next time your feet are aching or swollen, take a moment to consider your water intake. A simple increase in hydration might be the first step toward relief.

May 15, 2025

How Gut Health Affects Foot Pain: Exploring the Inflammation Connection

Gut Inflammation and Foot Pain – What’s the Link? Foot pain is often blamed on overuse or injury—but new research highlights a less obvious cause: gut health. Specifically, gut inflammation and foot pain are more connected than you might expect. When the gut lining becomes compromised, harmful particles can leak into the bloodstream, triggering systemic inflammation. This inflammation may impact muscles, joints, and soft tissues—especially in the feet, where stress is frequent. Systemic Inflammation and Plantar Fasciitis One of the most common causes of heel pain, plantar fasciitis, is already driven by inflammation. But when systemic inflammation is present due to poor gut health, it can make symptoms worse and recovery slower. People with inflammatory diseases like rheumatoid arthritis or inflammatory bowel disease often experience foot pain, suggesting a deeper, whole-body link. Reducing systemic inflammation through gut care may provide relief for conditions like plantar fasciitis. Gut Microbiome and Joint Health in the Feet The gut microbiome—the complex ecosystem of bacteria in your digestive tract—plays a critical role in regulating inflammation and immune response. When the microbiome is imbalanced (a condition known as dysbiosis), inflammation can increase, affecting joint health across the body, including in the feet and ankles. Emerging studies show a strong connection between gut microbiome and joint health, indicating that good gut bacteria may help reduce chronic foot pain linked to inflammation. Nutrient Absorption: A Key to Musculoskeletal Foot Health Beyond inflammation, poor gut health also affects how your body absorbs nutrients, such as: Vitamin D Magnesium Omega-3 fatty acids These nutrients are essential for maintaining strong bones, muscles, and connective tissues. A gut that’s not absorbing nutrients efficiently could contribute to foot fatigue, pain, or slow injury recovery. How to Support Gut Health for Better Foot Health If you're dealing with persistent foot pain—especially conditions like plantar fasciitis—supporting your gut could be a game changer. Here are some steps to consider: Adopt an anti-inflammatory diet: Reduce processed foods, sugar, and excess alcohol. Add probiotics and fiber: These help maintain a balanced gut microbiome. Stay hydrated and active: Movement supports both gut motility and foot health. Get tested: A healthcare provider can check for nutrient deficiencies or inflammatory markers. By improving your gut health, you may also be reducing the underlying inflammation contributing to your foot issues. When to See a Chiropodist Foot pain shouldn’t be ignored. If your discomfort persists despite footwear changes or home remedies, a professional assessment is key. At Feet First Clinic, we look at the bigger picture—including possible systemic factors like gut health that may be influencing your pain. Final Thoughts on Gut Health and Foot Pain The body is more interconnected than we often realize. Research on gut inflammation and foot pain, systemic inflammation and plantar fasciitis, and the gut microbiome’s role in joint health is still growing—but one thing is clear: taking care of your gut may help your feet feel better too. Featured Photo by Sora Shimazaki

April 30, 2025

Top Neutral Running Shoes

Finding the best neutral running shoes is an important “step” for runners who want a natural, supported stride. Neutral running shoes are designed for those who don't require extra corrective features and benefit most from balanced cushioning and stability. Many people also look for lightweight running shoes that deliver comfort and speed without feeling bulky. In this guide, we’ll help you find the right pair! Many of these shoes, and others, are available at our Toronto foot clinic, Feet First Clinic, and foot specialists like chiropodists and podiatrists often suggest them for people with a normal gait or who supinate. https://www.youtube.com/shorts/0bVBNNUAUOc What are Neutral Running Shoes? To understand what neutral shoes are, it helps to look at different foot types and the way each moves during walking or running. Foot types are typically defined by the height of the arch and associated gait patterns: Flat feet: Minimal or no visible arch, often leading to overpronation, where the foot rolls excessively inward during movement. Around 40% of runners overpronate, and without the right shoes, overuse injuries like plantar fasciitis can develop. Runners with flat feet should consider stability shoes, sometimes the more restrictive motion control shoe. High arches: A very pronounced arch, often leading to underpronation (also called supination), where the foot rolls outward. Normal arch: A moderate, well-formed arch that’s about “halfway full.” It supports a relatively neutral walking or running gait without excessive rolling inward or outward. Neutral shoes are designed for individuals with a normal arch and a natural gait, meaning their foot doesn't overly roll in (overpronate). Neutral running shoes are also suitable for people with high arches who underpronate. These shoes prioritize cushioning and shock absorption over structural support or corrective features, offering a more flexible and natural ride. Unlike stability shoes or motion control shoes, which are more rigid, built to control motion and guide the foot into proper alignment, neutral shoes allow the foot to move more freely and comfortably, simply because this is okay for a normal arch and a normal gait doesn’t need guidance. The focus is on lightweight materials, responsive cushioning, and smooth transitions from heel to toe. Comfortable neutral shoes are ideal for runners or walkers who have an efficient gait cycle and don’t require additional support to prevent injury. They can also be a good option for individuals with high arches, who often benefit from extra cushioning to protect against the increased impact that comes from less natural shock absorption. How Do Neutral Shoes Prevent Foot Pain? Neutral shoes help prevent foot pain by offering ample cushioning and promoting the foot’s natural motion without interference. For people with normal arches and a stable gait, or high arches, too much corrective structure can actually cause discomfort or alter natural biomechanics. Neutral shoes support a smooth stride while providing the soft, consistent underfoot feel needed to absorb the repeated impact of walking or running. One of the key ways neutral shoes protect against foot pain is by reducing the jarring forces that travel up through the feet and legs with every step via shock absorption. High-quality cushioning materials, such as EVA foam or advanced proprietary foams, spread out impact forces and minimize stress on the heels, arches, and forefoot. This protection helps prevent common issues like plantar fasciitis (heel pain), metatarsalgia (pain in the ball of the foot), and even joint discomfort in the knees and hips. Additionally, neutral shoes are often lighter and more flexible than stability or motion control shoes, which can reduce fatigue over longer distances. With less weight to lift and more natural foot mechanics, you can stay active longer and more comfortably. The result? A smoother, more enjoyable experience every time you move. And your feet aren’t too tired at the end of the day! Top Neutral Running Shoes in 2025 Where do you start when you want to find the right pair? Luckily, we’re going to talk about some of the best options. Some of these are available at our Toronto foot clinic, Feet First Clinic, and come highly recommended by chiropodists and podiatrists. You can always call or visit us to determine what high quality footwear we have in stock at any given time. ASICS Gel-Nimbus 27 The ASICS Gel-Nimbus 27 is a premium neutral running shoe designed for comfort and durability. It features a high stack height of 43.5 mm at the heel and 35.5 mm at the forefoot, providing ample cushioning for long-distance runs and everyday walking. The midsole utilizes ASICS' FF Blast Plus Eco foam, offering a soft yet responsive ride. A PureGel insert under the heel enhances shock absorption, which reduces joint strain. The engineered jacquard mesh upper is both breathable and supportive, contributing to the shoe's overall comfort. Despite its cushioning, the Gel-Nimbus 27 maintains a relatively lightweight profile, making it suitable for daily training. This model is ideal for runners seeking a plush, cushioned experience during long runs or recovery days. But it's not just for runners! It's also ideal for people with foot pain, arthritis, or who want to keep their feet comfy and supported as they go about their daily activities. Its premium cushioning makes it feel like you're walking on a cloud. Whether you're training for a marathon or enjoying a leisurely jog, this shoe offers the support and comfort needed to keep you going. It's also fantastic for non-runners who just want a comfortable walking shoe. Saucony Triumph 23 The Saucony Triumph 23 is another top-tier neutral running shoe with a stacked heel, known for its plush cushioning and smooth ride. It features PWRRUN+ foam in the midsole, delivering a soft yet responsive feel underfoot. The shoe's geometry promotes a natural stride, and the updated upper provides a secure, comfortable fit. Its durable outsole offers reliable traction, ensuring confidence on various terrains. Overall, the Triumph 23 combines cushioning, support, and durability, making it a versatile choice for runners and non-runners alike. The cushioning also delivers great shock absorption, while the mid-rocker sole reduces strain on the forefoot - great for people with high arches and joint rigidity. This shoe is particularly well-suited for runners who prioritize comfort and support over speed. The Triumph 23's design caters to those who spend extended periods on their feet, whether during training sessions or daily activities. Its combination of cushioning and stability makes it a reliable choice for a wide range of runners. Brooks Ghost For those who don’t want a stacked heel, the Brooks Ghost is renowned for its balanced cushioning and reliable performance. This neutral running shoe offers a 12 mm heel-to-toe drop, catering to runners who prefer a traditional feel. Its DNA LOFT v3 midsole provides a smooth, responsive ride, while the engineered mesh upper ensures breathability and comfort. The durable rubber outsole enhances traction, making it suitable for various surfaces. The Ghost 16's consistent performance and comfort make it a go-to option for daily training and long-distance runs. Ideal for runners seeking a dependable and straightforward shoe, the Ghost 16 delivers a comfortable experience without unnecessary frills. Its design focuses on providing a smooth transition from heel to toe, accommodating a variety of running styles. Whether you're a seasoned runner or just starting out, the Ghost 16 offers the support and comfort you need. It's also great for people who wear custom orthotics.

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