Extensor Tendonitis
Midfoot Pain

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What is Extensor Tendonitis?

The extensor tendons are a group of tendons on the top of the foot.  They start up in the front of the leg (in the anterior anatomic compartment) and pass down the leg along the shin, in front of the ankle, and across the top of the foot at they head out into the toes.  They lie just under the skin on the top (dorsal surface) of the foot. There job in life is to pull the toes up away from the ground (a motion called dorsiflexion by doctors). 

 

Extensor tendonitis is simply an inflammatory condition of the tendons and/or tendon sheaths that help guide and lubricate the tendons. It often occurs in active people like runners, hikers, skiers, cyclists and triathletes. 

 

Many people who have tendonitis on the top of the foot will think that they have a stress fracture in the foot.  Although the condition is painful, it usually can be treated quickly and without surgery. 

 

What Causes Extensor Tendonitis?

Any mechanical friction or compression of the tendons on the top of the foot can cause extensor tendonitis. A very common cause is from over-tightened shoes. 

 

The extensor  tendons are covered only by a thin, lightly-padded layer of skin. Just underneath the tendons are several bones (such as the cuneiforms, cuboid, navicular and metatarsals). By cinching your shoe laces tight, cranking down the straps on your cycling shoes, or buckling your ski boots too tight, you are putting those vulnerable little strands of tissue between a rock and a hard place. 

 

If you then go out and run, hike, ride or ski with these tendons compressed they can become irritated and inflamed.  The tendon sheaths then swell. This causes even more compression and irritation of the tendons. 

 

 

 

Symptoms of Extensor Tendonitis

You might have a extensor tendonitis if you have any of theses signs and symptoms: 

• Pain in the top of the foot without any specific trauma or injury

• Pain gets worse as with activity (walking, running, or standing)

• You find it hard to participate in some activities

  (such as running, climbing, cycling, hiking, rollerblading or skiing)

• Pain in the top of the foot, heel or arch, even at rest

• You noticed swelling or bruising on the top of the foot

• A tender spot over the hard bones in the midfoot 

• Top of the foot hurts much worse with tight shoes

• You had a gradual increase in pain after some activity

• Limping or changes in the way that you walk

 

Diagnosis of Extensor Tendonitis

When you have pain on the top of the foot that could be extensor tendonitis, your foot doctor will begin by taking a complete history of the condition to make sure that he has the full story. A physical exam will also be performed. X-rays are usually performed on the first visit as well to look for any change in joint alignment or possible fractures that can mimic the pain of extensor tendonitis. 

 

The history, exam and x-rays may sufficient for your foot surgeon to get an idea of the treatment that will be required. In some cases, it may be necessary to get an ultrasound, MRI or CT scan to further evaluate the anatomy on the top of the foot.  MRI is excellent at evaluating inflammation in the tendons and making sure there are no torn tendons (ruptures). 

 

 

The results of these tests can usually be explained on the first visit. In this way,  you can get a full understand of how the extensor tendonitis started, what you can do to treat prevent it from getting worse, and which treatments will be best to heal the inflamed tendons and tendon sheaths.

 

Treatment of Extensor Tendonitis

The simplest treatments for extensor tendonitis will target reducing irritation and controlling inflammation. In many cases changing the way you lace your shoes can help. If you skip one of the lacing holes so that the laces don’t run over the painful spot, the area may calm down. Icing can be very effective in reducing the inflammation as well. 

 

Occasionally, immobilization in a fracture walking boot is required to stop the friction of the tendons associated with walking. Crutches are almost never needed.  Physical therapy can also help decrease inflammation quickly. 

 

Steroids and Cortisone are very effective at decreasing pain and inflammation. In severe cases these injections can help break up the cycle of inflammation that causes the pain. If you are active, make sure you discuss your planned activities with your doctor.  These injections can increase the risk of  tendon ruptures. 

 

Anti-inflammatory Medications (such as ibuprofen, naproxen and other NSAIDs) can make the tendons and top of the foot feel better. Your doctor will help you determine whether or not this will be enough to get you better.

 

Pain Relievers (such as Tylenol and narcotics) can make the foot feel better, but do little to decrease the inflammation. Pain medicines can also mask the pain and allow you to walk on the foot and further irritate the tendons. This can cause more inflammation and potential for further injury. 

 

 

 

Surgery for Extensor Tendonitis?

Fortunately, surgery for the extensor tendons is only needed to repair ruptured (completely torn) tendons.  It is generally not performed for extensor tendonitis. 

 

When to see a Foot Specialist for a Extensor Tendonitis?

Any time you have pain, tenderness, redness or swelling on the top of the foot, you should seek treatment with a foot and ankle expert.  If this develops into chronic inflammation it can eventually lead to weakening and possibly even tearing of the tendons later on. 

 

Because extensor tendonitis can also mimic other conditions like soft tissue tumors, bone tumor or stress fracture, you should immediately make an appointment with a foot and ankle specialist.  The sooner you start healing, the sooner your pain will go away.  And the sooner you will be back to the activities that you enjoy.

 

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