Extensor Tendonitis

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A tendon is a cord of strong, flexible tissue, similar to a rope. Tendons connect your muscles to your bones. It let us move our limbs and they also help prevent muscle injury by absorbing some of the impacts your muscles take when you run, jump, or do other movements. Generally, your body contains thousands of tendons. Therefore, you can find tendons from your head all the way down to your toes. For instance, the Achilles’ tendon, which connects your calf muscle to your heel bone, is the largest tendon in your body.

Furthermore, the extensor tendons are located in your hands and feet. The extensor tendons in your hands help you move your fingers, thumbs, and wrists. As for the feet, the extensor tendons are attached to the muscles at the front of your legs to the toes and run across the top of your feet with very little padding to protect them from a variety of injuries; these tendons have a very important role and are in the highest vulnerable locations. Below are the four extensor tendons in the top of the foot:

  • Extensor hallucis longus – which goes to the big toe joint.
  • Extensor hallucis brevis – which is the shorter tendon tear of the big toe joint.
  • Extensor digitorum longus – which goes to your four small toes.
  • Extensor digitorum brevis – this connects to the four small toes but does not cross the ankle.

Extensor tendonitis is simply an inflammation that is primarily located in your feet. It is usually caused by spending a lot of time on your feet or wearing shoes that are too tight. If you have tendonitis in your hands, it’s typically due to excessive use of the tendons in a short amount of time, or from sports or other activities that use the wrists.

Causes & Symptoms

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

  • Overtraining – When you are constantly putting stress on your feet while exercising, the feet need time off to recover and repair. If adequate time is not taken, issues such as extensor tendonitis can result.
  • Tight calf muscles – Tendons connect muscle to bone. So, if your calf muscles are tight, this creates an extra pull on the bones in the foot. The area can become inflamed and pain occurs.
  • Running habits – 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.

In the hands, the most common cause of extensor tendonitis is doing an activity that uses the hands and wrists in a repetitive motion, such as:

  • Prolonged or high-impact typing with a non-ergonomic keyboard.
  • Playing sports that stress the hands and wrists, including baseball or tennis.
  • Practicing or playing an instrument, such as piano or guitar, excessively.

Mallet finger is a common type of injury that occurs to the fingers, especially in athletes. It happens when the tip of the finger is struck hard, such as with a ball, which injuries the tendon that runs along the top of the finger.

The feeling of pain is the most common symptom of extensor tendonitis. You may feel pain at the top of your foot, usually close to the center of your foot. You may also see swelling on the top of your foot and notice a large bump somewhere along the tendon. In your hands, you may feel pain at the top of your hand, including bruising and swelling. Other symptoms of extensor tendonitis that you may experience include:

  • Redness, warmth, or swelling around the affected tendon.
  • Increased discomfort during activities.
  • A sudden crunchy sensation or sound around the affected tendon.
  • Stiffness of the joint around the tendon.
  • Inability to move your toes.
  • Inability to freely move your thumbs, fingers, and wrist.
  • Numbness or tingling around the affected tendon.

Who gets Extensor Tendonitis?

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Certain factors that may increase the risk of developing extensor tendonitis for both your feet and hands include the following below:

  • 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.
  • Improper shoes – Wearing shoes that are too small or don’t fit properly, or lacing your 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 increase the risk of the condition.
  • Repetitive movements – Over-stressing your hands or feet while playing certain sports, doing housework, or working in a poor workplace ergonomics, can all place you at a higher risk of developing extensor tendonitis for both your hands and feet.
  • Acute injury – from falls, motor vehicle accidents, and non-penetrating blunt injury may cause extensor tendonitis. In severe cases, the tendon may also tear. Sometimes, an extensor tendon injury does not cause symptoms initially, but over time the injury can worsen, thus leading symptoms to arise.
  • Medications – such as non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids. These medications may reduce the chances of tendon healing and weaken the structure of tendons if taken frequently or for long durations.

How does it affect you? How serious is it?

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Unfortunately, not all cases of extensor tendonitis can be treated with ice, rest, and other non-invasive means. In these cases, where the tendons are severely damaged or do not respond to other treatments, surgery may be required. Like any other surgery, all of them require incisions. Therefore, this means there is a slight chance of infection but with a low percentage of it happening. When infections do arise, however, they are considered serious.

Other complications of surgery regarding extensor tendonitis include:

  • Persistent hand / foot pain – Some patients tend to continue to have persistent pain after surgery.
  • Longer-term stiffness – Longer-term stiffness is typically caused by excessive scar tissue. Oftentimes, lack of use or exercise can cause scar tissue to build up in the soft tissue around the joint.
  • Nerve or blood vessel damage – During surgery, there’s a minimal chance that the nerves, veins, or tissue around your hands or feet can be damaged. Damaged nerves or blood vessels can cause numbness, pain, or lower blood flow around the affected tendon.
  • Blood clots – Because surgery affects the way blood flows around your knee, it can increase your risk of developing blood clots.

Recommended Treatment & Rehabilitation

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Extensor tendonitis is a fairly common condition, so a physician or a doctor at a walk-in clinic may be able to diagnose your condition. You may also need to see a podiatrist, a doctor who specializes in feet, or an orthopedist, a doctor who specializes in foot and ankle injuries. During your visit, your doctor will ask you about your symptoms and perform a physical exam.

Sometimes, an X-ray may be done to make sure there are no fractures causing your pain. In serious cases, other imaging tools may be used. These include ultrasound and magnetic resonance imaging (MRI), which provide detailed views of tendons, muscles, and other soft tissue. These other imaging tests can be helpful in making sure no other tendons or muscles are injured, or to identify other areas of the foot that might need medical attention.

Depending on the seriousness of extensor tendonitis, physiotherapy may be necessary, both for the feet and hands. Physiotherapy can help you learn a wide variety of stretches and strengthening exercises and can include treatments such as ultrasound to help heal your tendons. They will also consider your goals for a safe return to sport or daily activities. Therefore, here are some treatments that will be included in your program for a full recovery.

 

Pain management

Your physiotherapist will help you identify and avoid painful movements and show you how to correct abnormal postures to reduce stress on the hands or feet. Your therapist may recommend resting the affected area short-term and applying ice to the area to help alleviate pain. He or she may also apply a brace to restrict movement, allowing the tendons to heal.

Manual therapy

Your physiotherapist may use hands-on techniques, such as gently joint movements, soft-tissue massage, and stretches to get your hands or feet moving properly.

Range-of-motion exercises

You will learn exercises and stretches to reduce stiffness and help your injured area begin to move properly.

Strengthening exercises

Your therapist will determine which strengthening exercises are right for you, depending on your specific areas of weakness.

Patient education

Depending on the specific activities you plan on resuming, your therapist will teach you ways to perform actions, while protecting your hands and feet. For example, keeping the hand in a neutral position to reduce excessive force while performing repetitive tasks, and taking frequent breaks from walking are ways to decrease your chances of re-injury.

 

Functional training

As your symptoms improve, your physiotherapist will teach you how to correctly perform functional movement patterns using proper techniques, such as typing on a computer (for the hands) or slowly walking on soft surfaces (for the feet). This training will help you return to pain-free function on the job, at home, and when playing sports.

 

Below are exercises that can boost your recovery from extensor tendonitis affecting either your hand or your foot:

 

Fist forming

Begin by holding your affected hand out, with all of your fingers straight. Then slowly bend your hand into a fist, placing your thumb on the outside of your hand. Open your hand back up until your fingers are straight once again. Repeat this exercise 10 times a day.

Finger bends

Start in the same position as in the last exercise, with your injured hand held up straight. Next, bend your thumb down toward your palm while holding it for a couple of seconds, then straighten it. Bend your index finger down toward your palm. Hold it for a few seconds, then straighten it. Repeat the remaining fingers on your injured hand, one at a time.

Big toe stretch

Sit straight in a chair, with the feet flat on the floor. Bring the left foot to rest on the right thigh. Then, using the fingers, gently stretch the big toe up, down, and to the side. Keep the big toe in each position for 5 seconds. Repeat this stretch 10 times a day.

Toe curls

Sit up straight in a chair, with the feet flat on the floor. Lay a small towel on the floor in front of the body, with the short side facing the feet. Place the toes of one foot on the short side of the towel. Try to grasp the towel between the toes and pull it toward oneself. Repeat this exercise five times before switching to the other foot.

Alternative & Homeopathic Treatment

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You can try to treat your extensor tendonitis homeopathically. Some of these alternative treatments include:

  • Ice and heat application – Taking ibuprofen to relieve inflammation help alleviate symptoms, but ice can be another form of medication. To help reduce swelling, apply an ice pack wrapped in a towel for 20 minutes, 2-3 times a day.
  • Compression – A warm compress helps to increase blood flow. Compression alone helps to prevent the buildup of other fluids in your body and limits swelling getting rid of what is already surrounding the pain.
  • Herbs – One of the common herbs that helps reduce inflammation comes from turmeric, called curcumin.