Foot Extensor Tendonitis Causes and Treatment

Athlete with foot injury
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A common complaint among runners is the pain on the top of the foot, right under your shoelaces. In many cases, pain on the top of the foot is due to an inflammation of the extensor tendons, which run along the top of your foot and give you the ability pull your foot upward and straighten your toes. Inflammation of those tendons is called foot extensor tendonitis.

Symptoms 

If you’re dealing with extensor tendonitis, you’ll feel pain on the top of your foot as you’re running. You may see swelling on the top of your foot and notice a large bump somewhere along the tendon.

A simple test to determine if the pain on the top of your foot is a result of extensor tendonitis requires you to have a friend assist you. First, flex your foot down and push down on your toes. Now, provide resistance by having someone press on your toes. Then, try to pull your toes up against the resistance. If you're feeling pain across the top of your foot or along the extensor tendon when you're doing that, then you’re most likely dealing with extensor tendonitis.

Causes 

Some common factors that may lead to extensor tendonitis are very tight calf muscles, overtraining, and a fallen foot arch.

Extensor tendonitis can also be caused by lacing your shoes too tight or wearing shoes that are too small or don’t fit properly. Check your running shoes to see if they’re creating a pressure point along the top of your foot. For some runners, non-running shoes are the problem, so be sure you’re wearing comfortable shoes that fit properly when you’re not running.

Another possible cause could be a change in your running habits or training. Doing a lot of uphill running, especially on a treadmill where you don't alternate with downhill running, can place more stress on your foot extensor tendons and lead to inflammation. Downhill running also causes the tendons to lengthen, which could likewise result in inflammation.

Self-Treatment

For mild extensor tendonitis, the most effective treatments are stretching your calf muscle and reducing the inflammation with ice or anti-inflammatories. Talk to your healthcare provider to see if you should take anti-inflammatories. In addition to stretching your calves, you can also try self-massage using a foam roller or other massage tool. Once the extensor tendon is no longer inflamed, you’ll be able to run relatively pain-free.

You can also try changing your shoe lacing pattern and loosen your laces slightly. To relieve pressure on the top of your foot, try lacing your shoes across the shoe tongue in a ladder pattern, rather than in a typical criss-cross pattern.

In some more extreme cases, a podiatrist may recommend custom-made orthotics or another treatment, especially if you're dealing with fallen arches.

It's usually safe to run through foot extensor tendonitis if the pain is mild and it’s not affecting your gait. If you do find running to be too painful, even after changing your shoe lacing, take a couple of days off from running before you attempt it again. Like many minor running overuse injuries, extensor tendonitis often clears up after a few days of rest, especially if you catch it early.

When to See Your Doctor

If your pain doesn’t go away after trying the above treatments, you may be dealing with a different injury or condition. Other conditions with similar symptoms include metatarsal stress fractures, atypical gout, and degenerative arthritis. Consult your podiatrist or another healthcare professional to determine the exact diagnosis and next steps.

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Article Sources
  • Brucker J, Young C. Extensor Tendinopathy. American Medical Society for Sports Medicine. https://www.sportsmedtoday.com/extensor-tendinopathy-va-131.htm.