
Extensor Hallucis Longus Referred Pain Pattern
The extensor hallucis longus muscle attaches to the lower leg's small bone (fibula). It runs down the lower leg, crosses over the ankle joint, and connects to the top of the end bone of the big toe (distal phalanx).
The muscle causes pain and cramping in the big toe and top of the foot. You may also feel a dull ache in the ankle joint.
The extensor hallucis longus also contributes to hammertoe and plays a role in foot drop.
The Location of the Extensor Hallucis Longus Muscle

The extensor hallucis longus attaches to the small bone of the lower leg (fibula) and goes down the front of the leg to connect to the top of a bone located in the big toe (distal hallucis phalanx).
For detailed anatomy information: Extensor Hallucis Longus Muscle Anatomy
What are the movements of the extensor hallucis longus?



Extensor Hallucis Longus Pain And Symptoms
Symptoms include:
- Pain in the top of the foot around and in the big toe
- Weakness in the big toe when straightening or lifting the toe toward the body.
- Difficulty raising the big toe and front of the foot
- Numbness in the big toe and top of the foot
- Recurrent foot cramps at night
- Pain in the ankle, which is a deep ache and is described to feel like bone pain
- Pain along the front of the shin bone
- Contributes to the development of hammertoe
- Contributes to foot drop and “foot slap.”
As a muscle that connects the small bone of the lower leg to the big toe, the extensor hallucis longus dysfunction significantly affects the foot and ankle. The muscle contributes to pain in the big toe, foot cramps, and pain extending into the ankle, which may radiate up the front of the shin.
The extensor hallucis longus muscle also contributes to foot drop, which is the difficulty or the inability to bend the foot up toward the body. Foot drop affects walking and balance due to the lack of control in lifting the foot while walking. The foot tends to drop to the ground when bringing the foot forward to take a step, leading to tripping and falls.
If the muscle is chronically tight and not treated, it may contribute to a condition known as hammertoe which means the toe is bent at the middle joint and is difficult or impossible to straighten.
Products TWD Uses and Recommends For Low Leg Pain
TENS units are often recommended by doctors and physical therapists for muscle pain and tightness. The Belifu TENS Unit Muscle Stimulator is robust and reasonably priced.
Yoga Toes Gems help reduce foot and lower leg pain. The separators stretch the muscles of the feet and lower legs. Used regularly, they can also be helpful for some cases of bunions, hammertoes, and claw toes. It can also help with issues of plantar fasciitis pain. For Men's shoe size ten+ and women's shoe size 12+, consider Yoga Toes For Men
The Causes Of Extensor Hallucis Longus Muscle Pain
- Stubbing the toes
- Kicking a ball
- People who drive routinely drive in heavy traffic and repeatedly move their foot from the gas pedal to the brake.
- Pedaling a bike
- Climbing stairs
- Wearing shoes that are too short or narrow
- Wearing high heels
- Inactivity of the lower leg due to a cast
Stubbing the big toe is likely the most common extensor hallucis longus muscle injury. Banging your toe into a hard object gives you a sore toe and can also be the starting point of trigger point development.
Repetitive motions that require frequent bending and straightening of the foot at the ankle joint are also problematic. Stair climbing and driving in traffic, requiring constant movement between the gas and brake pedals, are examples of daily activities that overwork and stress the muscle.
If you frequently walk, jog, or hike on rough terrain or uneven ground, you may experience pain and soreness. When walking and running on uneven and rugged terrain, your ankles twist and turn, overworking the extensor hallucis longus muscle that struggles to maintain muscle and body balance.
Extended periods of standing, particularly on hard surfaces, exhausts the muscle leading to pain and foot and lower leg swelling.
Shoes that are too short cause the toes to bend up and bunch together, leading to tightness and muscle soreness in the top of the foot and front of the ankle that extends into the shin.
Sports that contribute to extensor hallucis longus muscle pain:
- Jumping sports such as basketball, volleyball, high jump, and broad jump takes a toll on the muscle in two ways, repetitive deep bending at the ankle joint to get airborne and the pounding of the feet and legs that occurs when landing.
- Sports that require sudden stops and starts and quick direction changes are troublesome for the extensor hallucis muscle. Soccer and tennis players, gymnasts, dancers, and martial artists are prone to extensor hallucis longus muscle injury.
Sombra Warm Therapy Gel provides warmth without the burning heat of other gels. An excellent choice for pain caused by trigger points, muscle/joint overuse and stiffness, and arthritis. If you have reoccurring leg or foot cramps, you should keep Somba on hand; it provides almost instant relief. (Not sold in stores)
Biofreeze Pain Relieving Gel is an excellent pain-relieving gel recommended for those with sudden onset muscle pain or recent injuries. It is better to use than warm therapy gels and creams for muscle pain caused by inflammation as it cools the area much like ice. If your pain is from a recent injury, use Biofreeze. It is excellent to use on painful feet, strained shins, and sore ankles.
Interesting Facts About The Extensor Hallucis Longus Muscle
- Trigger points in the extensor hallucis longus are common in children and are often considered to be growing pains. Working on the muscle's trigger points will relieve much of the pain.
- The extensor hallucis longus plays a role in stabilizing the ankle joint.
- It also plays a part in maintaining balance and proprioception, which is the ability of the body to sense and recognize its own location, movement, and actions without relying on vision.
- The extensor hallucis longus contributes to hammertoe if allowed to remain chronically tight. Permanent deformity of the toe can result if the muscles are not treated.
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Common Locations Of Extensor Hallucis Longus Trigger Points


To find the most common extensor hallucis longus muscle trigger point, start about halfway down the lower leg and an inch to the outside of the shin bone. Search for an exceptionally tender spot.
Extensor Hallucis Longus Muscle Self-Treatment Massage
It is natural to rub and press on the top of the foot and big toe when pain flares in the extensor hallucis longus because that is where it hurts. However, if the pain is due to trigger points, trigger points in the shin must be deactivated to provide lasting pain relief.
To find the trigger point, search for an exceptionally sore spot halfway between the knee and ankle and about an inch toward the outside of the shinbone. Stop and hold pressure for 10 seconds when you find the spot, and then continue your search for other trigger points down to the ankle. The diagram above shows the most common location of an extensor hallucis longus trigger point, but trigger points can form anywhere in the muscle belly.
Trigger points in the extensor hallucis longus muscle respond best to three treatments spread throughout the day, lasting 1-2 minutes per treatment. Treat the TrP until you can apply pressure on the area and pain and symptoms do not occur.
Because the extensor hallucis longus muscle is deep and covered by other muscles, it takes considerable pressure to treat the muscle effectively. TWD recommends using a tool for effective treatment and to save wear and tear on your thumbs and fingers.
The first tool is The Knobble. This tool can be used on the feet, lower and upper legs, hips, and low back. It is recommended for people who can easily bend and reach various areas of the body.
The second is The Thera-Cane. This is an excellent tool for reaching all areas of the body. It is beneficial for individuals who may have problems bending and reaching some areas of the body.
When self-treating using massage or trigger point techniques, be careful not to apply too much pressure. The amount of pressure applied should be a little uncomfortable but not painful. Think along the lines of it hurts, but it feels good. If all you feel is pain, let up on the pressure!
If you are unsure about self-treatment, search for a massage therapist, chiropractor, or physical therapist trained in trigger point therapy. They can show you how to find and treat specific TrPs.
How Long Before I Feel A Reduction In Pain?
You should begin to feel a reduction in pain and increased flexibility after 2-3 days of consistent treatments. You must continue treatments until all pain and soreness are gone; otherwise, the pain will return and may worsen.
Trigger Point Treatment For Extensor Hallucis Longus
You can learn to self-treat extensor hallucis and other trigger points. The Trigger Point Therapy Workbook is an excellent resource for finding and treating trigger points throughout the body. Instructions and diagrams will help you find and deactivate these painful areas and relieve your pain.
The book recommends using one of these tools for treatment.
The extensor hallucis muscle lies underneath other muscles, and treating trigger points can require considerable pressure. These tools protect your thumbs and fingers from injury and provide precise treatment. You can use all the suggested tools on other areas of the body.
The most versatile of the suggested tools is the Thera Cane Massager. The cane reaches hard-to-reach muscles like the back and feet for treatments. If you cannot bend and twist easily to reach various areas of the body, use this tool.
The Knobbler is another tool that works well on the extensor hallucis longus. The Knobbler applies precise pressure to a trigger point and can be used on large and deep muscles of the hips, legs, and feet.
If you find trigger points in the extensor hallucis longus, you will want to check these muscles for additional trigger points, known as satellite trigger points.
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References:
Clay, J. H., Allen, L., Pounds, D. (2015). Clay & Pounds' Basic Clinical Massage Therapy: Integrating Anatomy and Treatment (3rd ed.). Philadelphia, PA: Lippincott Williams & Wilkins
Finando, D., Finando, S. , (2005). Trigger Point Therapy for Myofascial Pain: The Practice of Informed Touch (1st ed.) Rochester, VT: Healing Arts Press.
Muscolino, J., (2016) Kinesiology: The Skeletal System and Muscle Function (3rd ed.). Maryland Heights, Missouri: Mosby.
Image Credits: Dreamstime