Extensor Tendonitis

Author: Chloe Wilson - BSc(Hons) Physiotherapy

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. 

Here, we will look at the common causes, symptoms and treatment options for this common foot problem. 

Extensor tendonitis is caused by irritation of the extensor digitorum and extensor hallucis longus tendons

Let's start by looking at how tendons work.  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 top of foot

Common Causes

Extensor tendonitis most commonly occurs due to the foot rubbing against a shoe.  It tends to affect people who spend long periods on their feet, people walking or running on uneven surfaces or up and down hills and people who lace their shoes too tightly. 

Calf tightness can also contribute to the condition as can altered foot biomechanics.  People with high foot arches are more likely to have pressure on the top of their foot, and people with flat feet find their extensor tendons under more strain, both of which increases the chance of developing tendonitis.

Extensor Tendonitis can also occur after an injury such as if you have dropped something heavy onto the top of your foot or kicking something. 

Symptoms of Extensor Tendonitis

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

Extensor tendonitis usually causes pain across the top of the foot

1)  Top of Foot Pain: Tends to be worse with activity and better with rest.  The top of the foot maybe tender to touch making it uncomfortable wearing shoes

2)  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 foot, you probably have the condition.

Treatment Options

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

Ice can help reduce the pain and inflammation associated with extensor tendonitis

1)  Rest: It is really important to avoid aggravating activities for ample time to allow the tendon to heal.  If it hurts, stop!

2)  Ice: Using ice regularly helps reduce the pain and inflammation.  Visit the Ice Treatment section to find out how to safely and effectively use ice.

3)  Medication: Non-steroidal anti-inflammatories such as ibuprofen and naproxen are often used to reduce pain and inflammation

4)  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 one of the lacing holes over the most painful area.  It sounds simple, but it really does make a big difference.

Calf stretches can be useful when treating extensor tendonitis.  Approved use www.hep2go.com

5)  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

6)  Orthotics: Shoe insoles and inserts can be used to provide padding and support the foot, taking any undue tension off the tendons

7)  Physical Therapy: Ultrasound therapy can help promote healing

8)  Steroid Injections: 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

What Next?

Tendonitis can occur in a number of locations around the foot and ankle.  Find out more in the foot tendonitis section, including achilles tendonitis which is a common cause of heel pain.  

Find out more about how to stretch and strengthen the calf muscles in the calf exercises section to help prevent and treat extensor tendonitis and other common causes of foot pain.

If this is not sounding quite like your pain, find out about other common causes of top of foot pain or visit the foot pain diagnosis section.  

Go to Tendonitis Overview or Homepage

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