How to Heal a Tendon Strain Lessons Learned From a Little Toe

Most people find me online these days due to my videos and ebook on elbow tendonitis. And because of that I end up getting a ton of questions about other injuries, like tendon strain and tendonitis, from other areas of the body. I’ve answered several of the big ones in my bicep tendonitis and tricep tendonitis posts, and soon I’ll be making my way to the achilles and patellar tendons too.

For these subjects I look to see what the published clinical research says works best, and translate it into a message anybody can understand.

But what about all those smaller tendons in the body that no one has written papers about? We want to fix those injuries too, right? That’s exactly what today’s post is all about.

Now, I can’t possibly do a video for every tendon in the body. Well I guess I could, but seriously, I don’t work that fast nor do I think it’s necessary.

So instead I’m going to show you how to create your own customized rehab protocol for any tendon in the body.

Luckily for you, I got a foot injury a few weeks ago that serves as a perfect case study.

I’ve had pain in my forefoot for a full week, right where the second toe joins the foot (2nd metatarsalphalangeal joint). Shooting pain in the front of my foot with every step.

It started on a Tuesday night. I had taken 3 weeks off from training after a move-gone-wrong (ended up somewhat homeless, having to stay with friends and family  for 2 weeks) and was finally ready to get back into training and have some fun. I began the day with a few games of Pickleball, did a little lifting in the afternoon and in the evening had a double session of Tae Kwon Do which ended with sparring. The pain began after class and worsened the next morning.

At first I thought I had crushed a nerve when front kicking my sparring partner. But then I did a Google search for anatomy of the foot and realized that didn’t make sense seeing as the nerve splits around the bones on the bottom of the foot. But one of the tendons of the flexor hallucis brevis runs directly over the bone, right where my pain was. You can see it here on the left.

flexor digitorum brevis tendon strain

So the first thing you need to do is familiarize yourself with the anatomy of the injury site.

Next begin my: 4 Step Process for Fixing Over-use Injuries

Step 1: Identify Offending Activity

Here’s the theory I came up with…

When dorsiflexion of the ankle decreases, the toes need to extend (bend back) more in order to walk or run. The more they bend back, the more they stretch the tendons on the bottom of your foot and this can lead to a build-up of micro-trauma.

dorsiflexion plantarflexion

Now, even on a good day I have crappy dorsiflexion in that ankle and have a maintenance routine I do regularly to keep things moving OK. But during this period my regular routine was shot to hell.  And to make matters worse, two other things happened that further restricted the ankle.

  1. Lots of sitting in the car. This position puts your ankles in a fairly plantar flexed position. Sit like this for hours at a time and your calves tighten, restricting ankle mobility.
  2. My Vibram toe shoes died and I wore my old running sneakers for a few weeks instead. Every shoe with an elevated heel (traditional running sneakers, dress shoes, high heels) puts you into a slightly plantar flexed position limiting calf stretch during the gait cycle.

Vibram Five Fingers

Do you see the theme? The less the ankle dorsiflexes the more the toes have to extend. It’s a common compensation pattern that messes up a lot of feet in the modern world we live in. I believe this is one of the reasons why we see so many hammer toes and bunions. The other is modern foot wear, but that’ll have to be another post.

Anyway, back to my poor little toe.

So after weeks of allowing my ankle to get stiffer and stiffer, forcing the tendons under my toes to stretch more and more, I go to sparring class. One good front kick to my partner’s chest pads, pushing the toes back into extension hard, was all I needed to over stretch that toe tendon and BOOM, tendon strain.

Step 2: Stop or Reduce Offending Activity Until Healed

No sparring class until healed. Plus, seeing as walking hurts, no running.

Step 3: Release Trigger Points, Adhesions & Scar Tissue

First thing is rolling the sole of my foot out on a tennis ball, focusing on the flexor digitorum brevis muscle. Clearly this spot needed some work because as soon as I put my weight down on the ball there was a reflexive “Oh shit!” that I blurted out. After a few minutes things felt about 30% better already.

To improve ankle mobility I foam rolled and used the Stick on my lower leg before doing performing a set of eccentric calf lowering exercises

Step 4: Strengthen Weak Tissues

If you’ve seen many of my posts from earlier this year, you know that eccentric exercise is the way to go for healing tendinopathy. So that’s what I’ve done for 2 sets of 12 reps everyday since.

I took a seat, flexed my toes under, and slowly pulled my second toe into extension. It hurt a little, but after the two sets were finished I stood up and tested it out. No pain! And after only one treatment. It was a little sore when I walked but it was now about 90% better.

It’s now 3 weeks later and I’ve repeated the strengthening exercise everyday since. There is no pain or soreness at all when I walk but it’s still uncomfortable when performing the exercise. I’ll continue until there is no discomfort at all with the eccentric contraction.

  1. Tennis ball arch just to increase circulation and mobility in foot (good measure)
  2. Take toe through eccentric contraction using manual resistance (2 sets of 12 daily)

You now have a blueprint for figuring out how to fix any tendon strain… ankle, wrist, fingers or toes.

Let me know how you make out.

10 comments

  • JAMIE — THIS POST CAME AT THE PERFECT TIME! I SPRAINED MY WRIST A FEW WEEKS AGO (WE ARE ON THE SAME INJURY TIMELINE LOL) AND HAVE SET ABOUT HEALING IT IN A SIMILAR FASHION. I PULLED OUT MY TRIGGER POINT WORKBOOK, CHINESE LINIMENT AND HEAT BUDDY. I DID HAND EXERCISES AND REALIZED I NEEDED TO STRETCH THE TENDONS AND LIGAMENTS AND PAY ATTENTION TO THE FOREARM, AS WELL, BOTH POSTERIOR AND ANTERIOR. I KNOW I HAVE FEW WEEKS TO GO YET — I AM REALLY MISSING MY PUSHUPS! WILL GET THERE SOON:) THANK YOU FOR ANOTHER GENIUS POST. SPEEDY RECOVERY FOR YOU!!

  • Thanks Phyllis! I love hearing about people like you putting the effort into understanding and caring for their body. We only get one per lifetime.

  • Hi Jamie : I keep following your posts and it’s incredible how when I had my tennis elbow problem I did exactly as you said with the Stick and Tera bar and the pain went away in few months…but now I am having another issue that I wonder if it’s a tendon issue or not. The connecting one between my peck and front shoulder ( tendon or ligament?) does hurt and I went to physiotherapy for some sessions and deep massages in the area to release tension and it did help. But doing some high rings swings brought the pain back and doing bench press became a bit hard ( unless close grip and lower weight) I tried to look for recovery exercises for that specific area but couldn’t find on your blog and youtube… what would you recommend?? thanks so much and keep up the great work!

  • Great post Jamie! I have read several of them and use some of the techniques you have demonstrated, especially the about below tendonitis as I have golfer’s elbow. I was wondering if you had any techniques on how to relieve pain from extensor tendonitis. It is all about stretching the calf muscle as I am very prone to calf cramps. Thanks.

  • Thanks Jamie. I love your meticulous analyses. I find them really helpful in understanding the mechanics of the body and hopefully incorporating them into my daily life thus avoiding injuries in the first place. Keep it up, you’re really valuable

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