Top of foot by big toe pain

A tendon is a type of body tissue that connects muscle to bone. If a tendon becomes inflamed — painful and swollen — the condition is called tendonitis.

In your hands, there are so-called extensor tendons that connect the muscles to bones that allow you to move your fingers. In your feet, extensor tendons connect the muscles that help you raise your toes and flex your feet to your bones. If one of the extensor tendons in your foot becomes inflamed, you have a kind of unusual condition called extensor tendonitis.

The extensor tendons in your feet are called the extensor hallucis longus, extensor hallucis brevis, extensor digitorum longus, and tibialis anterior.

You're at risk for this condition if you have a high instep. In contrast, if you land on the inner side of your foot when you walk, you're also a prime candidate. If you are a runner, dancer, skier, or ice skater, you may be more likely to get extensor tendonitis due to the tightly laced footwear these activities call for.

Symptoms of Extensor Tendonitis in the Foot

The main symptom of extensor tendonitis in the foot is pain on the top of the foot. It is often right where your shoelaces are. You may feel this pain while you are running or walking.

Sometimes, there is visible swelling or a bump on the extensor tendon that is injured or inflamed.

Diagnosis of Extensor Tendonitis in the Foot

Doctors may be able to diagnose tendonitis with only a physical exam and medical history. However, if your doctor is worried your pain could be caused by a different condition, they may order an X-ray or an MRI.

What Causes Extensor Tendonitis in the Foot?

Most cases of tendonitis are from repetitive motion and develop over time. However, they can also occur because of a sudden injury.

Extensor tendonitis, in particular, may be caused by:

• Shoes that are too small or tight
• Doing too many uphill workouts and not enough downhill ones
• Running on an unstable surface

How Can You Treat Tendonitis At Home?

You can treat some cases of extensor tendonitis at home. Rest the affected foot for two to three days. Use it as little as possible to give the tendons a break.

While you are resting your foot, put ice on it for 20 minutes every two or three hours. 

Wrap an elastic bandage around the injured area to reduce inflammation, or use a brace. Make sure the bandage or brace is not too tight and take it off before you go to sleep.

Try loosening your shoelaces or trying different shoes to see if that helps. You can also add some padding under the tongue of your shoe before you return to activity.

How Do Doctors Treat Tendonitis?

If your home treatment doesn't help your foot after two or three days, you should contact a doctor. 

Your doctor may recommend over-the-counter or prescription-strength medications such as nonsteroidal anti-inflammatory drugs (NSAIDS). Aspirin and ibuprofen are among the most common ones. These are available as oral and topical medications. Your doctor may also want you to have a corticosteroid injection, a steroid shot, to reduce inflammation. 

Your doctor may also recommend a platelet-rich plasma (PRP) treatment. In this treatment, doctors take your own blood, take out the blood fragments known as platelets, and then inject the platelets into the affected area. Experts are still studying this treatment, but many agree that it shows promise for treating chronic tendon pain.

Physical therapy may help to strengthen your muscles and stretch your extensor tendons to reduce pain. 

If you have tried the above treatments and you still have tendon pain, your doctor may recommend dry needling. During this procedure, a doctor inserts a needle into the tendon to stop further damage and promote healing.

If scar tissue is causing your tendonitis, an ultrasonic wave device can help remove scar tissue and ease your pain.

If you have severe tendonitis, and the tendon has started to pull away from the bone, surgery may be required.

How to Prevent Extensor Tendonitis

The following tips can help you prevent extensor tendonitis:

• Always do a warm-up and cool-down before and after exercise.
• Don't forget to stretch.
• Build your workout gradually (start slow and lower intensity).
• Train the muscles you will be using in advance of activities and sports you know you will be doing.
• Learn the proper form for any exercises you do.
• Exercise regularly (more than one time per week).
• Listen to your body, especially if you are not accustomed to exercising.
• Wear shoes that fit properly.
• Pay extra attention to how your feet feel while exercising after switching to new shoes.
• Don't delay more than a few days in contacting your doctor when experiencing foot pain.