Extensor hallucis longus (EHL) tendinopathy is a myotendinous pathology localized on the dorsal surface of the foot, which can lead to functional limitations and often develops due to mechanical overload. Although its prevalence is lower than other lower extremity tendinopathies, the difficulties in the diagnostic process and the potential for chronicity of symptoms increase the clinical importance of the subject. Unlike the terminological term tendinitis, histopathological findings in chronic cases point to a degenerative tendinosis process characterized by a failed healing response rather than an inflammatory process. This review aims to comprehensively address the complex pathophysiological mechanisms underlying EHL tendinopathy, modern diagnostic approaches, nuances in differential diagnosis, and current evidence-based treatment modalities in light of recent developments in the literature.