INFLAMMATION OF THE EXTENSOR TENDONS OF THE TOES (EXTENSOR TENDINITIS)


WHAT ARE THE EXTENSOR TENDONS?

The tendons which straighten the toes run along the top of the foot and are known as the extensor tendons. They are the tibialis anterior, extensor hallucis longus, extensor hallucis brevis, extensor digitorum longus and extensor digitorum brevis. These tendons can become inflamed causing pain and swelling. Inflammation of the tibialis anterior is most common but inflammation of the extensor digitorum muscles is rare.

WHAT ARE THE SYMPTOMS OF INFLAMED EXTENSOR TENDONS?

  • Pain on the top of the foot (dorsal foot pain).
  • Diffuse swelling on the top of the foot.
  • Pain along the top of the foot which is worse during running.
  • Pain when the tendons are passively stretched.


WHAT CAUSES INFLAMED EXTENSOR TENDONS?

  • Overuse
  • Badly fitting shoes or shoes that are laced far too tightly causing pressure on the top of the foot.
  • It can also be caused by a change in training methods or running terrain, particularly hill running. Running uphill means the extensor muscles must work harder to lift the foot and downhill they have to work harder eccentrically to slow the foot.
  • Running on icy or slippery surfaces can also be a cause.


WHAT CAN THE ATHLETE DO ABOUT INFLAMED EXTENSOR TENDONS?

  • Rest until there is no more pain.
  • Apply ice or cold therapy.
  • Alter shoes or get shoes that fit properly!
  • Ensure shoe laces are not too tightly tied.
  • Pad the shoe in the forefoot to take the pressure off.
  • Follow a rehabilitation program including strengthening of the extensor muscles and stretching the calf muscles at the back of the lower leg.


WHAT CAN A SPORTS INJURY PODIATRIST OR DOCTOR DO?

  • Prescribe anti-inflammatory medication
  • Advise on recovery and rehabilitation.
  • Stretching exercises, custom foot orthoses
  • ultrasound guided cortisone injections
  • Percutaneous Cryotherapy (Cryoplantalis)
  • Consider 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)
  • In very rare cases surgery is performed.