Extensor Tendonitis in the Foot

Imagine lacing up your running shoes for a morning jog, only to experience a sharp pain on the top of your foot with every step. You might wonder if it’s just a temporary discomfort or something more serious. This could be a sign of extensor tendonitis in the foot, an inflammation of the tendons responsible for lifting your toes. Understanding this condition and knowing how to prevent and treat it is essential for maintaining your foot health and you can keep your running going.

Short Summary

  • Extensor tendonitis in the foot is caused by risk factors such as overuse, footwear issues and training surfaces & techniques.
  • Proper diagnosis is necessary to identify symptoms of extensor tendonitis and differentiate from other injuries.
  • Treatment strategies include rest, activity modification, cold therapy & compression, proper footwear selection and rehabilitation exercises for stretching & strengthening to prevent recurrence.


Understanding Extensor Tendonitis in the Foot

Extensor tendonitis, also known as extensor tendinopathy, is a condition characterized by inflammation of the extensor tendons. These tendons assist with:

  • Lifting of the toes
  • Dorsiflexion of the ankle

The risk factors associated with extensor tendinitis in runners may include overuse and repetitive strain, footwear issues, and training surfaces and techniques, which can lead to foot pain. Knowing the causes and risk factors can help you prevent this condition, and understanding the treatment options can provide relief if you’re already experiencing symptoms.


Anatomy of Extensor Tendons in the Foot

Extensor Tendons in the Foot

The human foot is comprised of twenty-six bones, thirty-three joints, and more than one hundred tendons. Tendons are a type of soft connective tissue composed mainly of water and collagen that permit joint movements.1Hayes, A., Easton, K., Devanoboyina, P.T., Wu, Jian-Ping., Kirk, T.B., Lloyd, D. (2019). A review of methods to measure tendon dimensions. Journal of Orthopedic Surgery and Research. http://​creativecommons.​org/​licenses/​by/​4.​0/.  The extensor tendons are part of the musculoskeletal system and help extend the foot. They are connected to the leg muscles, including the extensor hallucis longus muscle, and the bones in the foot. The extension tendons connect to four tendons responsible for the extension of the foot, which are:

  1. Extensor hallucis longus
  2. Extensor hallucis brevis
  3. Extensor digitorum longus
  4. Tibialis anterior

These muscles, including the calf muscles, help to lift up the toes and dorsiflex the ankle. These tendons play a crucial role in walking and running, enabling dorsiflexion and lifting of the toes.


Identifying Symptoms of Extensor Tendonitis

If you’re experiencing pain, swelling, stiffness on the top of your foot, you might be dealing with extensor tendonitis. These symptoms are often aggravated by activity and relieved by rest, making it essential to pay attention to your body and adjust your running activities accordingly.

It’s important to differentiate extensor tendonitis from other foot injuries that may present similar symptoms. A medical professional can help diagnose the condition and rule out other foot injuries, such as stress fractures or tibialis anterior tendonitis, through physical examination and diagnostic tests.


Causes and Risk Factors for Extensor Tendonitis

Extensor tendonitis can be caused by a combination of factors, including overuse, poorly fitting footwear, and training on uneven or slippery surfaces. These factors can lead to additional stress on the extensor tendons, causing inflammation and pain.

Overuse and Repetitive Strain

The primary cause of extensor tendonitis is typically attributed to overuse and repetitive strain. This occurs when the tendons are exposed to excessive stress, resulting in inflammation and pain. Inadequate stretching and strengthening, improper footwear, and training surfaces and techniques are all risk factors associated with overuse and repetitive strain.

Footwear Issues

Ill-fitting or overly tight shoes can be a contributing factor to extensor tendonitis. Inadequate footwear, such as shoes that do not fit properly or laces that are too tight, can lead to increased pressure on the extensor tendons, thus increasing the risk of injury.

To minimize the likelihood of extensor tendonitis caused by footwear, selecting footwear that fits correctly and provides adequate cushioning may assist in preventing extensor tendonitis.

Training Surfaces and Techniques

Training on uneven or slippery surfaces can increase the likelihood of developing extensor tendonitis. Running uphill or on slippery surfaces may place strain on extensor muscles and tendons.

To avoid the development of extensor tendonitis, it’s important to modify your training techniques and surfaces, such as running on softer, even surfaces, and incorporating lower-impact exercises.


Diagnosing Extensor Tendonitis

To diagnose extensor tendonitis, a medical professional will perform a physical examination, including a resisted dorsiflexion test, where the patient attempts to flex their toes towards them while the examiner applies resistance to the movement. A positive result of this test, accompanied by pain, may indicate potential extensor tendon injury. In some cases, imaging tests, such as X-rays or MRIs, may be necessary to confirm the diagnosis and rule out other foot injuries.


Treating Extensor Tendonitis: Strategies for Recovery

Once diagnosed with extensor tendonitis, there are several strategies that can be employed to aid in the recovery process. These include:

  1. Rest and activity modification
  2. Cold therapy and compression
  3. Proper footwear selection and use including loosening your laces
  4. Medication and medical intervention
  5. Rehabilitation exercises for extensor tendonitis

In the following subsections, we will explore each of these treatment strategies in more detail.

Rest and Activity Modification

Rest is imperative for facilitating healing and allowing the tendons to recuperate without additional strain. Considerations for expedite the healing process are:

  • Take a break until your discomfort subsides
  • Training when the foot is sore will only aggravate the injury and impede the recovery process.


If the injury persists or the tendon deteriorates, the mending process could take even longer.  Although moving your foot hurts, the right kind of activity can help your injured tendon. Studies have shown that complete immobilization can have negative consequences.2Cook J. L. (2018). Ten treatments to avoid in patients with lower limb tendon pain. British journal of sports medicine


Cold Therapy and P.R.I.C.E

Treating Extensor Tendonitis can often be treated safely at home using the P.R.I.C.E. principle. The acronym stands for:

  • Protection
  • Rest
  • Ice
  • Compression
  • Elevation

The principles of P.R.I.C.E. should be used for the first 48 – 72 hours immediately after the injury. The goal during this time frame is to control the amount of swelling to the injured area, prevent further injury, and reduce pain. Following these principles can effectively reduce the amount of swelling in an injured area thereby reducing the amount of time required for rehabilitation.  More info on P.R.I.C.E..

Proper Footwear Selection

Selecting the correct shoes and replacing them periodically can help to avoid direct pressure on extensor tendons and prevent recurrence of extensor tendonitis. Shoes that provide good arch support, are flexible, lightweight, and of the right width are recommended for preventing and treating extensor tendonitis. In particular, the Women’s Fresh Foam X 1080v12, Men’s Fresh Foam X 880v13 or the Mizuno Wave Inspire 14 Running Shoes can be considered for their cushioning, support, and shock absorption.

The The v12 and v13 offers a supportive, second-skin style fit with an engineered Hypoknit upper which may releive pressure on the extensor tendons.


Medication and Medical Intervention

In some cases, over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs), may be effective in reducing pain and inflammation. OTC medications are those that you can acquire without a prescription from a doctor.  These include:

Low dose aspirin (100 mg or below)

High dose (325 mg or above) aspirin

Ibuprofen ( Advil, Motrin)

Naproxen (Aleve, Naprosyn).

NSAIDs offer speedy relief with fewer side effects than corticosteroid medications; however, it is important to be aware of drug interactions and possible side effects prior to using them.

It’s important to consult a medical professional for appropriate treatment options based on the severity of the condition and individual circumstances.

Rehabilitation Exercises for Extensor Tendonitis

Rehabilitation exercises, including stretching and strengthening exercises, can be an essential part of the recovery process for extensor tendonitis.

In the following subsections, we’ll explore specific stretching and strengthening exercises that can be incorporated into your recovery plan.

Stretching Exercises

Stretching exercises targeting the extensor muscles can improve flexibility and reduce tension in the affected area. Some recommended stretching include:

Big Toe Stretch

Sit tall in a chair and keep your feet positioned flatly on the floor. With your left leg, bring your foot up to comfortably rest on the thigh of your right leg. Use the fingers of your hand to tenderly stretch the big toe in an up, down, and side-to-side motion. Carry on for 10 seconds and repeat 10 times before changing to your other foot and doing the same procedure on the right. Other stretches include:

  • Kneeling with the feet pointed backwards to stretch the extensor muscles
  • Stretches of the Achilles tendon and plantar fascia

It’s important to begin with gentle stretches and to perform strengthening exercises only when pain-free and with gentle intensity.

Strengthening Exercises

Building strength in the extensor muscles can help better support the tendons and prevent overuse injuries. Some recommended strengthening exercises include:

Toe Curls

This exercise serves to develop the flexor muscles of the toes and feet, enhancing the overall strength of these body parts. To perform this exercise: start by sitting up straight in a chair with both feet flat on the floor. Place a small towel on the floor in front of you and place one foot on one side of the towel. Utilizing your big toe and second toe, grasp the ends of the towel and pull it towards you, holding for five seconds. Repeat the same routine for five more reps. When complete, switch to the other foot and repeat the routine.  Other stretches include:

  • Calf raises
  • Heel raises
  • Ankle circles

When performing these exercises, it’s essential to use the correct form and technique, begin with light weights, and gradually increase the weight as the muscles become stronger.

Furthermore, ensure to rest between sets and avoid overworking the muscles. This will help to ensure that the muscles are not overworked and that the exercises are done correctly.


Preventing Extensor Tendonitis Recurrence

After recovering from extensor tendonitis, it’s crucial to take measures to prevent its recurrence. Ensuring proper footwear, making necessary training modifications, and performing regular stretching and strengthening exercises can all help prevent future injuries.

In the following subsections, we’ll discuss each of these preventative measures in more detail.

Footwear Considerations

Selecting well-fitting shoes and replacing them as needed can help avoid excessive pressure on the extensor tendons and prevent extensor tendonitis recurrence. Shoes that provide cushioning, support, and shock absorption, such as the Women’s Fresh Foam X 1080v12, Men’s Fresh Foam X 880v13 or the Mizuno Wave Inspire 14 Running Shoes can be considered, are recommended for preventing extensor tendonitis recurrence.

Training Modifications

Adjusting training techniques and surfaces can help reduce strain on the extensor muscles and tendons. Here are some ways to prevent extensor tendonitis recurrence.

  • Modify activities to lower impact exercises
  • Run on softer surfaces
  • Perform prehabilitation exercises
  • Incorporate eccentric muscle training

By implementing these strategies, you can help prevent extensor tendonitis from recurring.

These modifications can help reduce the risk of injury and improve performance. It is important to remember that it is important to remember that.

Stretching and Strengthening

Regularly performing exercises to maintain flexibility and strength in the extensor muscles can help prevent future injuries. Incorporating the stretching and strengthening exercises discussed in Section 7 into your routine can aid in maintaining the health of your extensor tendons and preventing extensor tendonitis recurrence.

Extensor Tendonitis vs. Other Foot Injuries

Differentiating extensor tendonitis from other foot injuries is critical for proper treatment and recovery. Here are some key differences to look out for:

  • Extensor tendonitis presents with pain, swelling, and stiffness on the top of the foot.
  • Stress fractures may cause pain when the toes are pulled outwards.
  • Tibialis anterior tendonitis typically manifests as pain in the anterior region of the ankle.

By understanding these differences, you can better identify and address extensor tendonitis.

Professional assessment and diagnosis are essential for determining the appropriate course of treatment for your specific foot injury. Seeking medical attention promptly if your symptoms worsen or persist after a few days can help ensure the most effective treatment options are implemented and expedite the recovery process.


In conclusion, understanding extensor tendonitis and its causes, symptoms, and treatment options is essential for maintaining foot health and staying active. By selecting proper footwear, modifying training techniques, and regularly performing stretching and strengthening exercises, you can prevent the development or recurrence of extensor tendonitis. Remember, if you suspect you have extensor tendonitis or any other foot injury, seeking professional medical advice is crucial for an accurate diagnosis and appropriate treatment plan.

Frequently Asked Questions

What does extensor tendonitis in foot feel like?

Extensor tendonitis in the foot can cause pain on the top of the foot, especially when running or walking. This pain is usually located where the shoelaces are and there may also be visible swelling or a bump.

Shoes that are too tight can increase your risk of developing the condition.

Is it OK to walk with extensor tendonitis?

It is generally safe to walk with extensor tendonitis, although you should take some time to rest after walking and speak to your healthcare provider before engaging in more physical activities.

Resting is important to allow the tendon to heal and to prevent further injury. It is also important to speak to your healthcare provider to ensure that the activity you are engaging in is safe and appropriate for your condition.

How long does extensor tendonitis in foot take to heal?

Extensor tendonitis in the foot typically takes 2-4 weeks to heal although symptoms can last three months. However, if you don’t follow the recommended advice, symptoms can take up to one year to improve for some people.


Sources and Studies

  1. Cook J. L. (2018). Ten treatments to avoid in patients with lower limb tendon pain. British journal of sports medicine
  2. . Hayes, A., Easton, K., Devanoboyina, P.T., Wu, Jian-Ping., Kirk, T.B., Lloyd, D. (2019). A review of methods to measure tendon dimensions. Journal of Orthopedic Surgery and Research. http://​creativecommons.​org/​licenses/​by/​4.​0/.