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Extensor Tendonitis

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Extensor tendonitis is a medical condition, in which the extensor tendons of the foot become inflamed. The extensor tendons are the ones that cross the foot and allow for the toes to be straightened. The main characteristic of this condition is pain, which is felt at the top of the foot. In the causes section, you will discover that, often times, extensor tendonitis is caused by the inflammation or irritation of the extensor tendons (due to friction, compression or inadequate footwear).

In this condition, both of the extensor tendons are affected, meaning the one of the extensor hallucis longus muscle and the one of the extensor digitorum longus muscle. This condition affects the dorsiflexion movement, occurring often in those who are physically active or in professional athletes. Those who run, hike, ski, cycle or take part in the triathlon run a higher risk of developing extensor tendonitis. This condition is often confused with the stress fractures that can occur at the level of the foot. Even though one might experience intense pain, it is important to remember that this condition can be usually remedied with the help of non-invasive methods of treatment (no surgical intervention required).

Symptoms of Extensor Tendonitis

These are the most common symptoms of extensor tendonitis:

  • Pain at the top of the foot
  • The pain is aggravated by movement and intense physical effort (running)
  • The stretching of the tendons, through the curling of the toes, can elicit a lot of pain
  • Diffuse swelling is also present over the top of the foot
  • The pain is reduced with the resting of the affected foot
  • The patient might present tenderness to the touch or feel discomfort when wearing shoes (especially if they are ill-fitting or tight)
  • Bruising might also be present at the top of the foot
  • Taking part in activities that are demanding from a physical point of view might be difficult
  • The pain can radiate to the other parts of the foot, such as the arch or the heel
  • You might have a tender spot over the hard bones that are located at the level of the midfoot
  • The pain might increase if the patient continues to perform activities that are physically-demanding
  • The pain can become so intense, that it might prevent the patient from standing or walking properly (limping can occur, as the patient avoids placing weight on the respective foot).

Causes

These are the most common causes that can lead to the appearance of extensor tendonitis:

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  • Overuse – this is often encountered in those who are professional athletes
  • Inadequate footwear – ill-fitting or tight shoes (cause pressure on the top of the foot, leading to the inflammation of the tendons)
  • Change in training methods – for example, if you run uphill (outdoors on the treadmill), one is causing more stress to be placed on the extensor tendons located on top of the foot; at the same, running downhill is also a subject of stress of the extensor tendons
  • Running on ice/slippery surfaces – as the person tries to maintain his/her balance, a lot of stress is placed on the extensor tendons (so as to avoid falling)
  • Spending a lot of time standing (occupational hazard)
  • Tying one’s shoelaces too tight
  • Calf tightness (contributes to the altered biomechanics of the foot)
  • Having a high foot arch (increased risk for developing such problems)
  • Flat feet (the extensor tendons are under constant stress)
  • Trauma or injury (for example, being in an accident or dropping something heavy on your foot)

Diagnosis

The diagnosis of the extensor tendonitis is made upon the physical examination. There is one diagnosis test that can be used in order to make the final confirmation. For this test, the doctor will require that you flex your foot in a downward direction (dorsiflexion movement). At the same time you are performing the movement, the doctor will apply resistance on top of the toes. The doctor will ask you to pull your toes upward, fighting against the resistance. If pain appears at the top of the foot or along the midfoot (where the tendon passes), it will be certain that you are suffering from extensor tendonitis. Based on the diagnosis, the doctor will be able to recommend the ideal treatment and measures that you need to take, in order to improve the symptoms of your condition.

Extensor Tendonitis Treatment

These are the most common measures and treatment solutions that you can consider for extensor tendonitis:

  • Rest – you need to avoid physical movement and rest, allowing the pain to subside (if you continue to train, enduring through the pain, you will only make the condition worse)
  • Ice – in order to obtain the desired pain relief, pack an ice pack in a towel and apply it to the affected area. You can maintain the ice pack for approximately 10 minutes every hour. Do not apply the ice pack directly on the skin, as you can suffer from circulatory problems (burning sensation).
  • Heat – the application of heat is recommended only after the acute period has passed and the pain has subsided. Heat applications are indicated in extensor tendonitis, in order to reduce to promote a more efficient healing process.
  • Wear adequate footwear – avoid wearing shoes that are ill-fitting or too tight. Choose shoes that are made from comfortable materials and make sure that you do not tie your shoes too tight. Use training shoes for physical activity, making sure that you replace them when they are worn.
  • Physical therapy – in the acute phase, the physical therapist will recommend the best positions you can assume, in order to benefit from reduced pain and not inflict any more damage on your tendons. Afterwards, the physical therapy program will concentrate on passive and active stretching exercises, strengthening of the muscles and balance improvement. Calf stretches are essential for a good recovery.
  • Anti-inflammatory medication – among the recommended choices, there are: ibuprofen, acetaminophen and naproxen. The doctor will decide whether you will take oral or topical anti-inflammatory medication, depending on how much pain you are experiencing.
  • Corticosteroid injections – recommended only in the situation that the pain experienced is really intense. The treatment cannot be administered for prolonged periods of time, as it can lead to the weakening of the extensor tendons.
  • Orthotics – the doctor might recommend that you wear shoe insoles or adapted inserts, in order to provide the necessary support for the foot and relieve the tension from the tendons.

Recovery time

Usually, the pain is the best symptom that can indicate the recovery time. In general, it is recommended that you avoid movement, for as long as you experience the pain. Depending on the cause of the extensor tendonitis, the recovery time can vary from a couple of weeks to several months. Physical therapy can reduce the recovery time and it is essential for those who are professional athletes (they can resume their physical activity faster with the help of physical therapy). If you do not have a physical activity to return to, you need to be patient and give your body the necessary time to recover from the problem.


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