Are you experiencing pain on the top of your foot? It might be because the tendons there are inflamed. If so then you likely have a condition called extensor tendonitis. These tendons, known as extensor tendons are connected to your toes and play an important role in foot movement.
Every time you walk, run, or jump the extensor tendons help lift the front of your foot and allow you to move your toes. Unlike other areas of the foot, the skin over the extensor tendons is quite thin and lacks the protective cushioning of muscles or fatty tissue. This lack of protection makes the extensor tendons more prone to irritation, strain, and injury, particularly during activities that place extra stress on the top of the foot.
What Causes Extensor Tendonitis?
Extensor tendonitis usually develops due to repeated stress or pressure on the tendons at the top of the foot. Unlike acute injuries that happen suddenly, extensor tendonitis often develops gradually. It’s common for pain to start mildly and get worse over time, particularly with ongoing activity.
Various factors can increase the risk of developing this condition.
Long Hours on Your Feet
Spending long hours on your feet without wearing supportive shoes can cause extensor tendonitis. This may be your situation if you have a job that requires it.
High Impact Sports
Athletes are also more prone to developing it as repetitive motion can strain the extensor tendons. Runners, dancers, skiers, basketball players, or anyone who enjoys high-impact sports is at risk of developing it.
Wearing Shoes That Are Too Tight
Tight shoes can compress the top of the foot and irritate the tendons.
Running on An Inclined Surface
Running on inclined surfaces--up or downhill-- is also known to increase the likelihood of extensor tendon strain. This can occur when you run the hills around town or increase the incline too much on a treadmill.
You can learn more about other precautions to take when running on a treadmill here!
Tight Calf Muscles
Tight calf muscles can also add stress to the tendons and can increase your risk of developing this form of tendonitis.
Poor Foot Mechanics
People with flat feet or high arches are also at greater risk.
Certain Health Conditions
Finally, health conditions such as rheumatoid arthritis and osteoarthritis can increase your risk.
Symptoms of Extensor Tendonitis
In addition to pain at the top of the foot, you may also notice or experience the following:
- redness
- warmth
- swelling over the extensor tendons
- stiffness
- difficulty moving your toes
- pain in the ball of your foot when you pull your toes upward
- numbness or tingling
- crepitus - a crunching sensation when pressing on the tendon
These symptoms can worsen with continued use of the foot and may persist if not treated.
Diagnosis of Extensor Tendonitis
To diagnose extensor tendonitis, we’ll examine your foot and look for signs of tendon inflammation, such as redness, tenderness, and swelling. To rule out other causes of pain, like stress fractures, we’ll order an X-ray and sometimes an MRI to determine the extent of the problem.
Treatment of Extensor Tendonitis
To treat extensor tendonitis initially, we’ll focus on reducing your inflammation and pain. Most cases take around two to four weeks to heal, but recovery times can vary depending on the severity of the condition.
If you have pain in the ball of the foot we'll address this separately.
You can begin treatment at home by using the RICE protocol. Rest and elevate your foot for several days as much as possible to reduce strain on the tendons. Ice it for 20 mins several times a day. Use an ACE bandage to wrap it to keep down the swelling. Use an over-the-counter anti-inflammatory medication if your doctor approves it.
At the office we offer the following treatments:
MLS Laser Therapy - this laser treats pain and inflammation and heals the tendon at a deeper, cellular level. Learn more about MLS laser therapy here!
Custom Orthotics - If poor foot mechanics are contributing to your tendonitis, we’ll cast you for custom orthotics. They can help take pressure off the tendons by properly aligning your feet.
Stretching With an Achilles Splint - Tight calf muscles can make your extensor tendonitis worse. If you have tight calf muscles I'll recommend stretching with an Achilles splint.
Purchase Shoes Designed for Your Sport
It’s also important to wear shoes with good support and athletic shoes that are designed for the sport you engage in to help in your recovery.
Physical Therapy
Physical therapy can assist in strengthening and supporting the affected tendons.
Preventing Extensor Tendonitis
There are several steps you can take to prevent extensor tendonitis or reduce the chance of it recurring.
Proper Footwear
- Start by ensuring you’re wearing properly fitted footwear.
- It’s important to have your feet measured each time you buy new shoes, as poorly fitting shoes can lead to increased strain on the extensor tendons.
- Replace athletic shoes every 500 miles or as soon as you notice signs of wear
Limit Running on Hills
If you tend to run up or down hills or use the incline on a treadmill, limit these activities as much as possible.
Custom Orthotics Wear
Be sure to wear your custom orthotics all the time if you have them since foot imbalances can be a cause of this condition.
Warm-Up and Cool Down
Do an adequate warm-up before any physical activity such as dynamic stretching. Be sure to stretch after your activity.
Engage in Strengthening Exercises
Strengthening exercises for the top of the foot, as well as regular stretching of the calf muscles, can provide support to the tendons and make them more resilient to injury.
By understanding the causes, symptoms, and preventive steps, you can manage extensor tendonitis effectively and take steps to keep your feet healthy and pain-free.
