Foot Extensor Tendonitis Causes and Treatment

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A common complaint among walkers, runners, and other exercisers is pain on the top of the foot, right under your shoelaces. In some cases, this pain is due to an inflammation of the extensor tendons, resulting in a condition called foot extensor tendinopathy or "tendonitis."

The extensor tendons run along the top of your foot and give you the ability to pull it upward and straighten your toes. Though rare, you can also get extensor tendonitis in the hand. In both cases, the tendons are vulnerable because they aren't protected by bones, muscle, or fatty tissue.

Symptoms of Extensor Tendonitis

If you’re dealing with extensor tendonitis, you’ll feel pain on the top of your foot as you’re running or walking. 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, extensor tendonitis is likely the cause.

Causes of Extensor Tendonitis

Figuring out what is causing your foot pain is the first step to finding ways to treat it. Some common factors that may lead to extensor tendonitis are:

  • Tight calf muscles. Tendons connect muscle to bone. So, if your calf muscles are tight, this creates extra pull on the bones in the foot. The area can become inflamed and pain occurs.
  • Overtraining. When you are constantly putting stress on your feet while exercising, they need time off to recover and repair. If adequate time is not taken, issues such as extensor tendonitis can result.
  • Fallen foot arch. Having flat feet can also contribute to tendonitis on top of the foot. A fallen foot arch changes the foot's structure which can create issues with the extensor tendon, causing it to become inflamed.
  • Running habits or training. Doing a lot of uphill walking or running, especially on a treadmill where you don't alternate with downhill workouts, 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.
  • Shoe-related causes. Wearing shoes that are too small or don’t fit properly, or lacing shoes too tight, can all contribute to extensor tendonitis by creating a pressure point along the top of your foot. Non-athletic shoes can also be the problem, so be sure you’re wearing comfortable shoes that fit properly when you’re not exercising too.

Treating Top of Foot Pain

If you are experiencing pain on the top of your foot, you have two basic options. You can try to treat it yourself or you can see a doctor.

Self-Treatment

Extensor tendonitis often clears up after a few days of rest, especially if you catch it early. For mild cases, also try stretching your calf muscle. You can do this by using a towel to pull your big toe toward you or by trying to spread your toes as far apart as you can.

Self-massage using a foam roller helps too, and ice and anti-inflammatory medications can be used to reduce inflammation, swelling, and pain. Compressions and braces may be used to support the foot or ankle, providing greater stability to the pained area.

Also try loosening your laces and lace your shoes across the shoe tongue in a ladder pattern, rather than in a typical crisscross pattern, to relieve pressure on the top of the foot.

It's usually safe to exercise 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, take a couple of days off before you attempt it again. Once the extensor tendon is no longer inflamed, you’ll be able to walk or run relatively pain-free.

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

Prevention

By taking a few simple actions, you can help reduce your chances of having extensor tendonitis, or of it reoccurring if you've been diagnosed with this condition in the past.

Preventing foot extensor tendonitis begins with not overly stressing the foot with too much training or by placing too much pressure on the feet at one given time. Instead, work to build up the strength and resilience of the soft tissues around your feet slowly over time.

Wearing good fitting shoes is important too. If your shoes fit correctly, the tops of your feet are less likely to become irritated or inflamed. This involves, in part, choosing shoes that are meant for the exercise you do, whether walking, running, or other gym exercise.

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3 Sources
Verywell Fit uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Adams J, Habbu R. Tendinopathies of the hand and wrist. J Am Acaad Orthop Surg. 2015;23(12):741-50. doi:5435/JAAOS-D-14-0016

  3. Kindred J, Trubey C, Simons SM. Foot injuries in runnersCurr. Sports Med. Rep. 2011; 10: 249–54. doi:10.1249/JSR.0b013e31822d3ea4

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