What Is Extensor Tendonitis?
A tendon is a type of body tissue that connects muscle to bone. If a tendon becomes inflamed— painful and swollen— the condition is called tendonitis.
In your hands, there are so-called extensor tendons that connect the muscles to bones, allowing you to move your fingers. In your feet, extensor tendons connect the muscles that help you raise your toes and flex your feet to your bones. If one of the extensor tendons in your foot becomes inflamed, you may have a condition called extensor tendonitis.
The extensor tendons in your feet are called the extensor hallucis longus, extensor hallucis brevis, extensor digitorum longus, and tibialis anterior.
You're at risk for this condition if you have a high instep — the arched middle part of the foot, between your toes and ankle. Also, if you land on the inner side of your foot when you walk, you're at risk. If you're a runner, dancer, skier, or ice skater, you may be more likely to get extensor tendonitis due to the tightly laced footwear these activities call for.
Extensor Tendon Zones
Extensor tendon zones are areas that doctors use to identify where exactly the irritation or pain is. There are four extensor tendon zones in each foot.
Heel tendonitis
Heel tendonitis, officially called Achilles tendonitis, is a common form of the condition. Your Achilles tendon runs from the calf of your leg to your heel bone, and it's used a lot throughout your daily activities. It allows you to walk and run, climb, jump, and raise your heels so you can stand on your toes.
People who run are at the highest risk of developing heel tendonitis. If you’re a weekend athlete or a middle-aged person engaging in physical activities where there is a lot of stopping and starting, such as tennis, you also have a higher risk of injury.
Heel tendonitis symptoms include:
- Mild ache that worsens over time, starting above the heel and moving up
- Increasing discomfort after running or climbing stairs
- Tenderness
- Stiffness
Foot tendonitis (outside of foot)
If you have foot tendonitis outside of your foot, it could beperoneal tendonitis, which affects the tendons around the outer part of your ankle bone.
Symptoms include:
- Ankle pain that you can feel going along your tendon
- Pain that increases with physical activity
- Swelling or redness around the tendon
- Feeling that the tendon is thicker than usual
- Mass or nodule that you can move when you push on it
Extensor tendonitis (top of foot)
The tendon that runs along the top center of your foot can become irritated and cause pain. This is caused by extensor tendonitis. People who have flat feet or high arches are at risk of this type of tendonitis. Symptoms include:
- Pain that runs along the length of the top of your foot, especially while running or walking
- Swelling on the top part of your foot
- A bump along the tendon
Symptoms of Extensor Tendonitis in the Foot
The main symptom of extensor tendonitis in the foot is pain on the top of the foot. It's often right where your shoelaces are. You may feel this pain while you're running or walking.
Sometimes, there is visible swelling or a bump on the extensor tendon that is injured or inflamed.
Diagnosis of Extensor Tendonitis in the Foot
Doctors may be able to diagnose tendonitis with only a physical exam and medical history. To check your foot, your doctor will likely press on the painful area. This is to feel for swelling and find out where you feel the worst pain. Your doctor will also want to see how your foot moves to check your range of motion to see if any particular movements make the pain worse.
If your doctor isn’t sure or is worried that there may be something else causing your pain, you might be sent for an X-ray, ultrasound, or MRI.
What Causes Extensor Tendonitis in the Foot?
Most cases of tendonitis are from repetitive motion and develop over time. However, they can also happen because of a sudden injury.
Extensor tendonitis, in particular, may be caused by:
- Shoes that are too small or tight
- Doing too many uphill workouts and not enough downhill ones
- Running on an unstable surface
Extensor Tendonitis Home Remedies
You can treat some cases of extensor tendonitis at home, but if the pain worsens or you start having other symptoms, check with your doctor for an accurate diagnosis. There might be another problem and not tendonitis.
Here are some things you can try to ease extensor tendonitis pain:
- Rest and elevate your affected foot for 2-3 days. Use it as little as possible to give the tendons a break.
- While you are resting your foot, put ice on it for 20 minutes every 2 or 3 hours. Do not apply ice directly to your skin though. It should be wrapped in a towel or cloth to avoid injuring the skin.
- Wrap an elastic bandage around the injured area to reduce inflammation. You could also use a brace. Make sure the bandage or brace isn't too tight and take it off before you go to sleep. Also, make sure the brace fits properly and doesn’t press into your skin anywhere as this could cause a sore.
- Try loosening your shoelaces or wearing different shoes to see if that helps. You can also add some padding under the tongue of your shoe before you return to activity.
- Take over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen if it's safe for you to do so.
Extensor tendonitis stretches
If you want to try extensor tendonitis stretches or exercises to strengthen your tendon, start slowly and gently. Do not continue them if you feel pain or the tendonitis returns. If you do have pain, you should see your doctor for a diagnosis in case your problem isn’t related to extensor tendonitis. It’s also a good idea to consult a physical therapist or sports therapist before starting exercises or stretching for a tendon problem, but if you’d like to start, here are a few suggestions:
Big toe stretch. While sitting in a chair, place your feet flat on the floor. Lift the sore foot to rest on the opposite leg. Gently use your fingers to move your big toe up and down and side to side. Repeat 10 times if this isn’t too painful.
Toe curls. Sit in a chair with a towel or cloth placed on the floor in front of you. Using your big and second toes, try to grab onto the towel. Hold it for a few seconds and then let go.
Foot stretch. While sitting in a chair, place your sore foot on your opposite thigh. Using your hand, press on your foot towards your body until you feel the top of your foot stretching.
Inversion hold. Using an exercise/tension band, lie on the floor with your legs straight. Loop the band around the bottom of the sole of your foot. Pull gently on the band until you start to feel tension. Make your foot resist the tension by pushing downward.
Extensor tendonitis foot wrap
If you are searching online for help to ease the pain from extensor tendonitis on your foot, you may come across websites that sell extensor tendonitis foot wraps. Luckily, you don’t have to spend extra money to buy one of these. Wrapping your foot with an elastic pressure bandage or an ace bandage does the trick.
Extensor Tendonitis Treatment
If home treatments don't help your foot after 2-3 days, or if the pain gets worse, you should contact your doctor.
Your doctor may recommend prescription-strength NSAIDs if the over-the-counter ones don’t help. Aspirin and ibuprofen are among the most common ones. These are available as oral and topical medications. Your doctor may also want you to have a corticosteroid injection (a steroid shot) in the area to reduce inflammation.
Your doctor might recommend a platelet-rich plasma (PRP) treatment. Your doctor takes some of your blood and removes blood fragments called platelets from it. The platelets are then injected into the affected area. Experts are still studying this treatment, but many agree that it shows promise for treating chronic tendon pain.
Physical therapy may help strengthen your muscles and stretch your extensor tendons to reduce pain.
Since this type of tendonitis can be caused by flat feet, your doctor could recommend you get orthotics, a kind of special shoe inserts that help support your foot’s arch. Sometimes, a soft cast might be helpful too.
If you’ve tried the above treatments and you still have tendon pain, your doctor may recommend dry needling. During this, a doctor inserts a needle into the tendon to stop further damage and promote healing.
If scar tissue is causing your tendonitis, an ultrasonic wave device can help remove scar tissue and ease your pain.
Foot tendonitis surgery
Sometimes, tendonitis is severe and the tendon starts to pull away from the bone. If this happens, you may need surgery. It’s rare, but if you don’t feel better after 6 months of treatment, surgery may be your best bet. There are a few options:
- Tenosynovectomy: A surgeon removes damaged tissue and stitches the remaining healthy tissue back together.
- Tendon transfer:A surgeon uses a healthy tendon taken from another part of your foot and puts it in place of the damaged tendon.
- Ultrasound-guided hydrodissection (TenJet): Your doctor will use an ultrasound to remove damaged tissue from the tendon.
How to Prevent Extensor Tendonitis
The following tips can help you prevent extensor tendonitis:
- Always do a warm-up and cooldown before and after exercise.
- Don't forget to stretch.
- Build your workout gradually (start slow and at a lower intensity).
- Train the muscles involved in your planned activities and sports ahead of time.
- Learn the proper form for any exercises you do.
- Exercise regularly (more than one time per week).
- Listen to your body, especially if you aren't used to exercising.
- Wear shoes that fit properly.
- Pay extra attention to how your feet feel while exercising after switching to new shoes.
- Don't delay more than a few days in contacting your doctor if you're having foot pain.
Takeaways
Extensor tendonitis in the foot is a fairly common injury that can happen with overuse of the foot. It usually results from running more than usual or participating in a sport where you stop and start frequently. It can also happen if you have flat feet or high arches. Tendonitis can be quite painful but resting your foot (stopping the activity that may have caused the pain), elevating it, and wearing supportive shoes may help stop the irritation.
Extensor Tendonitis FAQs
What does extensor tendonitis in your foot feel like?
Extensor tendonitis causes pain running along the length of the top of your foot, especially while running or walking.
How long does it take for extensor tendonitis to heal?
Luckily, extensor tendonitis is usually a temporary injury. However, the time it takes to heal depends on several things, such as how irritated the tendon is and if you’re continuing to walk or run on your foot. The recovery time can be a few weeks or a few months.
What happens if you leave extensor tendonitis untreated?
If you continue to use your foot without allowing your tendon to heal, you have a risk of the tendon tearing. If this happens, you might need surgery to repair it.
