Extensor Tendonitis In Foot: Causes, Treatment & Recovery Time

The foot is used to walk, run, jump, and do so many things which makes it prone to injuries. The foot has a lot of soft tissue structures like the muscles, ligaments, and tendons. When any of these get injured or inflamed, it causes a lot of discomfort and difficulty walking.

A tendon is a soft tissue that joins muscles to bones. When an action is about to be done, the muscle works through the tendon to move the bone so if a muscle is overworked, the tension is felt at the tendon because it passes information from the muscles to the bone to carry out the expected action.

In this post, we will be taking a closer look at Extensor Tendinitis, which is the inflammation of the tendons of the foot extensors.

foot extensors

What Is Extensor Tendonitis?

Extensor Tendonitis is the inflammation of the tendons of the muscles that extend the foot. These muscles are called extensor muscles of the foot and are found at the top of the foot. The extensor muscles are very important in helping us walk and because of the work they do, they can become irritated and inflamed.

There are two major extensor muscles:

  • Extensor digitorium brevis which is responsible for bending the second, third, and fourth toes upward
  • Extensor halluxis brevis which is responsible for bending only the big toe upwards

The tendons are directly under the skin in a flat fascia and are prone to injuries because they do not have enough protection.

What Causes It?

  1.  Calf tightness affects the calf muscles found at the back of the leg. The calf muscles are responsible for raising the heel off the floor and point the toes towards the ground. For us to walk, the calf lifts the heel off the floor and when the heel touches the floor, the extensors lift the toes off. Imagine when the calf muscles are tight and cannot lift the heel off the floor, there is a lot of work and strain on the extensor tendons which can lead to inflammation.
  2.  Standing for long periods of time.
  3.  Overtraining can injure the tendons. Imagine doing 100 burpees, 5 times a day. It involves you jumping off your toes and can cause a lot more than muscle soreness in your foot.
  4.  Wearing the wrong shoes affects the support the foot needs while walking or working out.
  5.  Wearing tight shoes places a lot of pressure on the extensor tendons of the foot. A tight shoe rubs against the extensor muscles that are superficial which forms friction and cause inflammation.
  6.  Foot deformities like flat foot which means the arch of the foot has collapsed or a high arch can overstretch the extensor muscles.
  7.  Trauma is an external force that can cause an injury like something heavy dropping on the foot or someone stepping on the foot.

trauma to the foot

What Are The Signs And Symptoms?

  • Pain at the top of the foot
  • Swelling
  • Bruising
  • Tenderness
  • Difficulty walking

How Is It Diagnosed?

1. Self Diagnosis

As mentioned before, the extensor tendons of the foot raise the top of your foot and make it possible to point the toes to the ceiling. To self diagnose extensor tendonitis, raise your toes and point them towards you. If pain is felt at the top of the foot then it is positive.

2. Diagnostic tests

When you see a doctor, an x-ray, CT scan or MRI is usually advised to rule out other conditions that may mimic the signs of extensor tendonitis. A CT scan and MRI will show the severity of the injury while an X-ray will rule out fractures or dislocations that may have happened at the foot or ankle.

How Is It Treated?

R.I.C.E. treatment.

1. Rest

Rest is recommended for this type of injury. Since the extensor tendons have a lot of work to do while we walk, the foot should stop all activities and take a break for at least 3 days depending on what your doctor and physiotherapist recommend.

Crutches or a foot brace is usually recommended to allow the foot to rest.

2. Ice

Ice is applied on the foot to reduce swelling. This can be done by an ice immersion which is to place the affected foot in a bowl of ice and water or place an ice pack on the top of the foot for 15 minutes. Ice can be applied every four hours.

3. Compression

Compression can help reduce swelling by wrapping an elastic bandage around the foot.

4. Elevation

This positioning is recommended to allow swelling to reduce. It is normally advised that the affected foot should be elevated at all times and raised above heart level. So when sitting, the foot is placed on a stool or chair and when lying, pillows can be used to prop up the swollen foot.

5. Medication

Non-steroidal anti-inflammatory drugs are prescribed for this type of injury to relieve pain and reduce swelling. Some of these medications are ibuprofen, diclofenac, and naproxen. Ointments with the same components are usually applied directly on the injured foot to help relieve pain.

6. Physiotherapy

Physiotherapy for the foot

Physiotherapy is the major part of rehabilitation and the supreme goal is to get your foot to how it was before the injury happened and to make sure the injury does not happen again.

A physiotherapist will assess your foot and then discuss the goals you will like and point you to other parts of the body like a tight calf that may contribute to a re-injury in the future. Some of these goals will be to:

  • Relieve pain by using electrical or thermal modalities
  • Reduce swelling through the use of ice, exercises or positioning
  • Stretch out any tight muscles
  • Strengthen weak muscles
  • Ensure you are well educated on the proper shoes to wear
  • Retrain your walking pattern so that you do not walk funny after getting better

Follow up with the physiotherapist is highly necessary to ensure that healing is going well and to upgrade exercises if need be as the healing continues.

7. Exercises

foot exercises

Exercises are prescribed by the physiotherapist and should be increased in frequency or intensity except advised against by the therapist. Some of the exercises that can be done are:

Calf stretches

Since a tight calf muscle is one of the causes, the calf needs to be stretched so that it does not affect the extensor tendons.

  • Stand facing a wall
  • Place the affected leg behind you and the unaffected one in front of you
  • Place your palms on the wall as if you want to push the wall
  • You will feel a stretch in the calf muscles of the leg placed behind you.

Foot Extensor Stretches

This exercise can also be called a toe curl

  • Bend your toes towards the back of your feet to stretch the extensor muscles
  • Hold for five to ten seconds and release

Foot Extensor Strengthening Exercises

  • Place your affected foot on a towel or cloth
  • Use your toes to pull the towel towards you
  • This can be repeated 5 times

Or

  • Use your toes to pick a pencil from the floor and move it from one point to another

Recovery time

Depending on how early treatment commences and when the necessary footwear and lifestyle modification comes in, extensor tendonitis may take at least three days to six weeks for the injury to heal completely.

How To Prevent It

Not seeing a doctor

  • Wear the right shoes
  • Loosen out your laces when you tie them to do any form of sporting activity
  • Warm up before doing any sporting activity to prepare your muscles for the work they are about to do
  • Do not forget to stretch especially after being in a position like standing for a long period of time
  • Listen to your body. Do not over train yourself because you are eager to get results. Take your time.
  • Strengthen the muscles in your legs
  • Get insoles that can provide support to the foot in your shoes

Conclusion

Extensor tendonitis is an inflammation of the tendons of the extensor muscles of the foot. Most causes of this injury can easily be avoided by sticking to the prevention plan written in this post. The foot can be affected by our shoes in ways we may not understand. Pay attention to your shoes and also to your feet.

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Adekanmi Lipede, M.Sc, MPH

Adekanmi Lipede is a licensed physiotherapist with a Master's degree in physical activity and public health from Loughborough University. She joined 25 Doctors in 2018 and is passionate about educating people about the best steps to take when trying to be physically fit or when recovering from a mobility-related condition. For fun, she loves to exercise and read.
Adekanmi Lipede, M.Sc, MPH