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Extensor Tendonitis Foot

In this article you will find out everything you need to know about extensor tendonitis in the foot and the most effective ways to treat the condition.

The feet are one of our body’s most mobile and unrested parts. If it were not for the feet, then moving from one place to another might have become a very crucial task. However, at the same time, moving from one place to another is a continuous activity. You cannot just sit back and imagine your work being done already without moving a foot.

Doing so often leads to additional stress on your feet without realizing it. For example, you may not be giving your feet enough rest or standing for long periods, all of which compromise foot health and ultimately lead to foot pain and other foot injuries.

However, the unfortunate reality is that the feet suffer a bit more than that, unlike the other parts of the body, which may only get strained or sprained for a short time after prolonged usage.

A variety of pathological and physiological conditions may develop within the legs and feet and cause trouble in the long run. Extensor tendonitis of the foot is one such troublesome and painful condition.

What Is Extensor Tendonitis? 

Understanding the dynamics of this condition requires understanding both the normal anatomy and the abnormality that causes it to develop over time.

An equally interesting fact is that extensor tendon injury can occur both in hand and the lower legs, although the causes differ in almost every case. The reason for this is the nature of the extensor tendon that causes it to develop different kinds of extensor tendinopathy, depending further upon the mechanism of injury that takes place in this region. [1]

Coming to the actual fact, tendons are extremely strong and fibrous cords that help connect muscles with bones. This enables the muscles to move across freely using the tendons as a support on which they can easily rely and carry out their movements.

However, sometimes, these tendons become inflamed due to different reasons. One of the most common reasons among them is the overuse of these tendons. But to sum it all up, the inflammation of those specific tendons that help extend your toes can result in the development of a condition called ‘extensor tendonitis’ of the foot. [2]

How Does Extensor Tendonitis Of The Foot Develop?  

The injuries related to the extensor tendon are very common. These tendons are easily injured because they technically lie in a very compromised and unprotected position. They are located near the top of the feet, where there is practically no subcutaneous tissue to protect them future injuries. [3]

These tendons are also located in a superficial position which further exposes them. This way, these tendons can easily get injured, ruptured, or sprained, depending on the cause of the injury.

The common extensor tendons located in the foot region include extensor hallucis longus, extensor hallucis brevis, extensor digitorum, extensor hallucis longus muscle, and tibialis anterior. Therefore, when any of these extensor tendons of the foot get torn, inflamed, or sprained, it is common for the affected person to develop a wide range of symptoms of varying intensities. [4]

Causes 

As we learned earlier, overuse cannot always be the culprit behind the development of extensor tendinopathy. Although it is one of the most common causes, still, there are some other causes as well that contribute to the development and occurrence of extensor tendinitis and tendonitis in the feet. [5]

Some of these common causes include:

  • Wearing fitting shoes that are either too tight or small for your size puts additional exertional stress on your foot that you would not have bargained for but gotten to experience for no good.
  • Running or jogging on uneven surfaces instead of flat ones. While you may not realize it, your feet will have to unduly compromise in adjusting to these rough and uneven surfaces, which will again put additional stress on the top of your foot, compromising the extensor tendons.
  • Some recreational and sports activities that cause repetitive motion put additional stress on your feet. These include ice skating, dancing, skiing, and other running activities. All these activities contribute to making a great part of the sports medicine-related injuries.

However, one thing worth remembering over here is that foot extensor tendonitis is significantly different than plantar fasciitis or Achilles tendinitis, which develops on the underside of the foot and is responsible for heel pain. Although plantar fasciitis pain is limited only to the heel region, the pain that occurs due to extensor tendonitis is felt in different regions of the foot. [6][7]

What Are The Symptoms Of Extensor Tendonitis Of The Foot? 

Usually, pain is the very first symptom to follow after the development of extensor tendonitis. This pain is usually felt on the top of the foot or sometimes on the front of the leg, indicating the place where your shoelaces are tied.

The affected person usually experiences this pain when they continue doing their usual activities – mostly those that caused the condition in the first place, such as running or walking with their tight shoes on.

Suppose the condition continues to persist and the person does not seek treatment. In that case, it is very much possible for the person to experience a swelling or even an inflamed bump at the top of the foot, exactly where the superficial extensor tendons lie. [8]

Following the development of extensor tendinopathy, it is also very common to experience pain during the movement of your toes. In addition, some people also experience a tight calf, which is usually due to the muscles being held in a constant state of stress, owing to the painful tendons.

How Is Extensor Tendonitis Evaluated And Diagnosed?

Based on a detailed medical history and physical exam of the foot from all sides, it is quite easy for a medical professional, usually a podiatrist or an orthopedic doctor, to diagnose extensor tendonitis of the foot.

Usually, the background history is sufficient enough to give clues about the impending condition, but if it is not the case, then a medical professional can order an X-ray or MRI (magnetic resonance imaging) to confirm the diagnosis. These radiological investigations are enough to diagnose the condition.

Treatment Of Extensor Tendonitis Of The Foot

Once a person is diagnosed with extensor tendonitis of the foot, then the next step is to work out the management and treatment options for the person, depending on the history and severity of the person’s symptoms.

Like any other condition, extensor tendinopathy also has two main approaches that are focused on resolving and treating the condition – a conservative or pharmacological one and a surgical one that is done only when the person shows resistance to the other forms of treatment or is not showing any progress to the ongoing treatment plans.

Both these treatment plans are discussed as follows:

Conservative Management

The non-surgical or supportive management of extensor tendonitis of the foot revolves around giving ample rest to the patient’s affected foot. There are high chances that the patient can achieve resolution of their symptoms if enough rest is provided to the aching foot.

Along with rest, cold compresses should also be used. They provide a cooling and soothing effect to the inflamed and tenderfoot and, in this way, help in relieving the pain and restlessness that develops in this condition. [9]

It is also recommended that people who are habitual to working out or doing activities that require them to use their feet strenuously should always start with some mild warm-up exercises to ensure that not too much pressure is exerted on their feet.

Other precautionary measures such as not wearing shoes, tying the shoelaces too tightly or placing your foot in a brace that helps lift off some pressure off the foot can also help in dealing with this condition effectively.

Taking medicines such as non-steroidal anti-inflammatory drugs (NSAIDs) such as Naproxen, Aspirin, and Ibuprofen have also been seen to help the patient in pain relief. At some other times, steroid injections such as corticosteroids can also help in reducing pain and relieve the inflammation. In addition, anti-inflammatory medications and analgesic creams also work as a good measure to reduce swelling and inflammation.

Physical therapy that includes foot strengthening exercises that are focused on strengthening the top of the foot area and stretching the extensor muscles is also greatly helpful.

Surgical Treatment

The surgical treatment of extensor tendonitis of the foot is usually not required as the supportive measures are enough to deal with the condition. The extensor tendonitis foot or tendinopathy is also self-healing and requires little maintenance to require the need for any surgical treatment. [10]

However, when surgery is done for this condition, it is usually in the form of an incision that is made between the two damaged or inflamed tendons. The idea is to receive the additional stress or exertional forces off from the tendons and make space for them to coexist peacefully. Then the incision is stitched back, and the resolution of symptoms is typically seen within a few days.

Prolotherapy

Some of the structures around the ankle have a poor blood supply, which is why they can struggle to heal on their own. It is the oxygen and nutrients in our blood supply that helps to heal these structures.

Prolotherapy involves the injection of a regenerative solution into these structures to provide a direct supply of what is required to heal and repair.

As the treatment is helping to reduce pain and treat the root cause of the problem, it is deemed to be a permanent fix.

Conclusion 

Any kind of extensor tendinopathy that occurs in the feet is not the end of the world. We have learned that the entire condition is treatable and can be managed very easily, sometimes at home.

Extensor tendonitis of the foot is a painful condition that makes walking and moving around quite difficult for the affected people. However, with great care and precautions, the person can continue living peacefully and without any pain for a long time.

Frequently Asked Questions

  1. How long does it take for extensor tendonitis of the foot to heal?

It takes about 2-3 months for the symptoms of extensor tendonitis of the foot to heal completely. In people with severe cases of this condition, it might take up to a year for the foot to heal and become pain-free completely.

Should I wrap my foot for extensor tendonitis?

Although it is not a definite solution, people usually find some relief in placing their affected foot in an orthotics’ brace. The brace helps in relieving any additional pressure over the feet and keeps it in a stress-free environment.

Can you walk with foot tendonitis?

It might be difficult to walk around with a condition like foot tendonitis, but it is not impossible. People can move around with foot tendinosis or tendonitis with great difficulty.

Can socks cause extensor tendonitis?

Wearing socks that are too tight for your feet and that put an additional stress over your feet can play their part in the development of extensor tendonitis.

Are Compression Socks good for tendonitis?

Compression stockings are a helpful option for extensor tendinopathy. They help keep the feet and legs in a packed state that is not too tight and this way, helps in relieving some inflammation from the feet.

Is heat good for extensor tendonitis?

It is better to opt for cold compresses than warm ones for extensor tendonitis as they help reduce the inflammation and keep the feet pain-free.

References

    1. Moore A, Marappa-Ganeshan R. Hand Extensor Tendon Lacerations. [Updated 2022 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554431/
    2. Pedrazzini, A., Valenti, P. G., Bertoni, N., Pedrabissi, B., Simo, H. Y., Bisaschi, R., Medina, V., Ceccarelli, F., & Pogliacomi, F. (2019). Traumatic extensor tendons injuries of the foot in childhood: a case report. Acta bio-medica : Atenei Parmensis, 90(12-S), 202–206. https://doi.org/10.23750/abm.v90i12-S.8933
    3. Kass, J. C., Palumbo, F., Mehl, S., & Camarinos, N. (1997). Extensor hallucis longus tendon injury: an in-depth analysis and treatment protocol. The Journal of foot and ankle surgery: official publication of the American College of Foot and Ankle Surgeons, 36(1), 24-7.
    4. Simpson, M. R., & Howard, T. M. (2009). Tendinopathies of the foot and ankle. American Family Physician, 80(10), 1107-1114.
    5. Tomlinson, M. P., & Williams, L. A. (2006). Extensor hallucis longus calcific tendonitis: a case report. Foot & ankle international, 27(2), 144-145.
    6. Medina Pabón MA, Naqvi U. Achilles Tendonitis. [Updated 2022 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538149/
    7. Buchanan BK, Kushner D. Plantar Fasciitis. [Updated 2022 Feb 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK431073/
    8. Kass, J. C., Palumbo, F., Mehl, S., & Camarinos, N. (1997). Extensor hallucis longus tendon injury: an in-depth analysis and treatment protocol. The Journal of foot and ankle surgery: official publication of the American College of Foot and Ankle Surgeons, 36(1), 24-7.
    9. Pfeffer, G. B., Michalski, M., Nelson, T., An, T. W., & Metzger, M. (2020). Extensor tendon transfers for treatment of foot drop in Charcot-Marie-Tooth disease: a biomechanical evaluation. Foot & Ankle International, 41(4), 449-456.
    10. Duarte, M., & Fradinho, N. (2021). A Combined Surgical Approach for Extensor Hallucis Longus Reconstruction: Two Case Reports. Indian journal of plastic surgery : official publication of the Association of Plastic Surgeons of India, 54(2), 225–228. https://doi.org/10.1055/s-0040-172152

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