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Extensor Tendonitis

Pain Across The Top Of The Foot

 EXTENSOR TENDONITIS

Foot and ankle tendonitis is a common cause of foot pain. It occurs when there is inflammation or irritation of the tendons, which is usually due to overuse from repetitive movements or stretching or an injury such as an ankle sprain.

Extensor tendonitis causes pain across the top of the foot. This form of foot tendonitis is caused by inflammation or irritation of the tendons that pull the toes up, usually from repeated friction or compression from a poorly-fitting shoe.

Tendons are tough, fibrous tissues that connect muscles to bones.  The extensor tendons join the muscles on the front of the lower leg to the toes. They pull the toes upwards away from the ground.

The two main extensor tendons come from extensor hallucis longus, which lifts up the big toe, and extensor digitorum, which lifts the other four toes.  Both tendons run down across the front of the ankle, across the top of the foot and then fan out attaching to the tips of the toes.

The tendons sit between the skin and the bones and there is little padding around them, making them prone to injury resulting in pain in the top of the foot.

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What Causes Extensor Tendonitis?   

When these tendons become over-stressed they become inflamed and painful. Swelling may accompany the inflammation. Most commonly it is the extensor tendon to the big toe (EHL) that is affected. In other instances the extensor tendons to the lesser toes (EDL) is affected. The most common factors that cause extensor tendonitis are excessive tightness of the calf muscles, overexertion during exercise and falling of the foot arch. A simple test to determine if the pain on the top of the foot is due to extensor tendonitis is to flex the foot downward and have a friend provide resistance to the top of the toes. Try to pull the toes upward against resistance. If you experience pain across the top of the foot or along the course of a tendon on the top of the foot then the diagnosis is likely extensor tendonitis.

Symptoms Of Extensor Tendonitis

The symptoms tend to be confined to the top of the foot, occasionally spreading to the arch of the foot:

  • Top of Foot Pain: Tends to be worse with activity and better with rest.  The top of the foot may be tender to touch making it uncomfortable wearing shoes
  • Swelling and/or Bruising: There may be some visible swelling and/or bruising across the top of the foot

A simple test for extensor tendonitis is to try and draw your toes up towards you while resisting the movement with your hand. If that recreates your pain on top of the foot, you probably have the condition.

Extensor Tendonitis Treatment

Treatment aims to reduce irritation, inflammation, and pain in the top of the foot. There are a number of things that can help:

  • Rest: It is really important to avoid aggravating activities for ample time to allow the tendon to heal.  If it hurts, stop!
  • Ice: Using ice regularly helps reduce pain and inflammation.  Visit the Ice Treatment section to find out how to safely and effectively use ice.
  •  Medication: Non-steroidal anti-inflammatories such as ibuprofen and naproxen are often used to reduce pain and inflammation
  • Shoe Laces: The simplest way to treat and prevent extensor tendonitis is to change how you lace your shoes.  Either tie your knot at the side or miss out on one of the lacing holes over the most painful area. It sounds simple, but it really does make a big difference.
  • Exercises: Strengthening exercises for the extensor muscles help to improve strength and endurance.  Calf stretches can also help as having tight calves puts more strain on the extensor tendons
  • Orthotics: Shoe insoles and inserts can be used to provide padding and support the foot, taking any undue tension off the tendons
  • Physical Therapy: Ultrasound therapy can help promote healing
  • Steroid Injection: If the pain fails to settle, a steroid injection can be given to help reduce the inflammation.  Care must be taken as it does temporarily weaken the tendon

The general principle for treating foot and ankle tendonitis is to give the injury rest so the body can heal it. This takes time, usually weeks to months. Your doctor may give you a walking boot to keep your foot and ankle immobilized so you aren’t using it, or you may be directed to have no weight bearing on the affected foot. Other conditions that mimic the symptoms of extensor tendonitis are; metatarsal stress fracture,; atypical gout;and; degenerative arthritis. For further information consult with your podiatrist.

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Arash R. Hassid, DPM

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Daniel L. Altchuler, DPM

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