Extensor Tendonitis

Extensor tendinitis is inflammation of the extensor tendons which run along the top of the foot and straighten the toes.

Extensor tendonitis symptoms

Symptoms of extensor tendonitis include pain on the top of the foot which is made worse during running. The athlete may feel pain when the tendons are stretched by curling the toes and there may also be some diffuse swelling over the top of the foot.

Extensor tendinitis explained

Extensor hallucis longus muscleExtensor tendonitis or extensor tendinopathy as it is probably better known now amongst the medical profession affects the tendons which pull the foot upwards. These are the tibialis anterior, extensor hallucis longus, extensor hallucis brevis and extensor digitorum longus muscles. The term tendonitis implies inflammation of the tendon whereas tendinopathy is a more general term which includes a degeneration of the tendon rather than acute inflammation.

Tibialis anterior muscleExtensor tendonitis is usually caused by overuse. Badly fitting shoes or shoes that are laced too tightly causing pressure on the top of the foot can cause inflammation of the tendons. A change in training methods, particularly running uphill, particularly on a treadmill can also place more stress on the extensor tendons at the top of the foot.

Running up hill means the foot has to be lifted slightly higher on each stride. Running down hill the muscles work eccentrically which again places stress on the extensor tendons as can running on ice or slippery surfaces.

Extensor tendonitis treatment

What can the athlete do about inflamed extensor tendons?

Cold pack on the footRest until the pain has gone. Continuing to train when the foot is painful will only make the injury worse and delay the healing. If it becomes chronic or the tendon degenerates then healing will take much longer.

Apply ice of cold therapy can be applied for 10 minutes every hour initially reducing frequency as required over the next 48 hours. Ice can be applied in a wet tea towel or with a re-useable ice pack. Do not apply ice directly to the skin as it may burn. Once the initial painful acute stage has passed then application of heat may be more effective.

Running shoesEnsure footwear is appropriate and in particular the shoes are not laced too tightly. Over tightening the laces puts direct pressure over the extensor tendons in the foot. It may help to try a different lacing pattern. Running shoes are usually good for 400 miles of running and then would benefit from being replaced.

When all pain has gone a full rehabilitation program to strengthen the extensor muscles should be done. A sports injury professional can advise on the correct exercises to strengthen the extensor muscles.

What can a sports injury specialist or doctor do?

Dorsi flexion ankle exerciseA professional will assess the injury and confirm the diagnosis ruling out the possibility of a metatarsal stress fracture. Often pain on passive stretching indicates tendinitis, but pain when the toes are pulled outwards might indicate a stress fracture.

A doctor may prescribe anti-inflammatory medication such as ibuprofen although this should not be taken if the patient has asthma. If it is a long term problem a steroid injection may be given although repeated injections to tendons can weaken the tendon. In very rare cases surgery is performed.