What is Extensor Tendonitis?

Extensor tendonitis causes pain across the top of the foot.  The extensor tendons join the muscles on the front of the lower leg, to the toes.  They pull the toes upwards away from the ground. The two main extensor tendons come from extensor hallucis longus, which lifts up the big toe, and extensor digitorum, which lifts the other four toes.  Both tendons run down across the front of the ankle, across the top of the foot, and then fan out attaching to the tips of the toes. The tendons sit between the skin and the bones; and as there is little padding around them, they are prone to injury resulting in top of the foot pain.


 It is caused by irritation, which most commonly occurs due to the foot rubbing against a shoe.  People affected are those who tend to spend long periods on their feet; those who walk or run on uneven surfaces, or up and down hills; and persons who lace their shoes too tightly.

Calf tightness can also contribute to extensor tendonitis, as can altered foot biomechanics.  People with high foot arches are more likely to have pressure on the top of their foot, while people with flat feet find their extensor tendons under more strain, both of which increase the chance of developing tendonitis. It can also occur after an injury, such as if you have dropped something heavy onto the top of your foot, or kicked something.


 The symptoms tend to be confined to the top of the foot, occasionally spreading to the arch of the foot:

  • Top of Foot Pain – Is usually worse with activity and better with rest. The top of the foot maybe tender to touch, making it uncomfortable to wear shoes.
  • Swelling and or Bruising – There may be some visible swelling and/or bruising across the top of the foot

A simple test for extensor tendonitis, is to try and draw your toes up towards you, while resisting the movement with your hand.  If that recreates pain on top of your foot, you probably have the condition.

Pay attention to Footwear

  • Good fitting shoes is crucial, even though you are not suffering from any foot ailments.
  • Good shoes provide cushion for the feet, comfort, and may help to prevent conditions like tendinitis.
  • Before you buy a pair of shoes for yourself, consult your podiatrist, to see if they can advise on some personalised tips, to allow for appropriate shoe choices.
  • Always opt for comfortable, well-fitting shoes, and avoid those that are too tight. Tight shoes usually produce unnecessary pressure on the feet, that may result in tendonitis.
  • The fact that choosing a well-fitting, comfortable shoe is a tedious job, one cannot recommend a set brand to everyone, wearing of shoes being a personal matter. One size and shape do not fit all


 The recommendations listed aim to reduce irritation, inflammation and top of foot pain:

  • Rest – It is really important to avoid aggravating activities, to permit ample time for healing of the tendon.
  • Ice – Using ice regularly helps reduce the pain and inflammation. Ice, works by anesthetising local top of foot nerves. It also helps to reduce swelling of the foot, by constricting blood capillaries.
  • Heat – Though ice compression can help with this condition, usually extensor tendinitis is a chronic disorder. So if you have been experiencing pain for awhile, then ice compression will not help. Heat compression is useful in such a scenario. Heat causes blood vessels to dilate, which increases blood flow to the affected area, triggering a speedy recovery. Heat also acts as a local muscle relaxant.
  • Medication – Non-steroidal anti-inflammatories, such as ibuprofen, are often used to reduce pain and inflammation.
  • Exercises – Strengthening exercises for the extensor muscles help to improve strength and endurance. Calf stretches can also help; having tight calves puts more strain on the extensor tendons.
  • Orthotics – Shoe insoles can be used to provide padding, while supporting the foot, taking any undue tension off the tendons.
  • Physical Therapy – Physiotherapy helps to relieve tightness in the tendons, foot and calf muscles, by stretching them at regular intervals.
  • Steroid Injections – If the pain fails to settle, a steroid injection can be given to help reduce the inflammation. Care must be taken though, as the tendon can be temporarily weakened.
  • Massages – Though it is not scientifically proven, in chronic conditions, gentle massage across the top of foot may help to reduce pain. Gentle massage improves the blood flow of the affected area, and helps chronic tendinitis to heal better. It also helps to relieve pain. Massage generally helps to stimulate the natural repair mechanism of the body that triggers healing.

Your feet mirror your general health . . . cherish them!

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