Tendonitis on the top of the foot, or extensor tendonitis, involves irritation or inflammation of the tendons that lift the foot and toes. These tendons extend from lower leg muscles, crossing the front of the ankle and spanning the upper foot to attach to the toe tips. This condition commonly arises from overuse or repetitive strain, leading to pain and discomfort. The thin skin and minimal protective tissue over these tendons make them susceptible to injury.
Initial Self-Care Measures
Immediate steps can help manage the discomfort of extensor tendonitis, beginning with the R.I.C.E. protocol. Rest means reducing or stopping activities that worsen pain to allow the tendon to heal. Apply ice to the affected area for 15-20 minutes at a time, several times a day, using a barrier like a thin cloth. This helps reduce inflammation and pain.
Compression with an elastic bandage or wrap helps reduce swelling; ensure it is not applied too tightly to avoid restricting circulation. Elevating the foot above heart level minimizes swelling. Over-the-counter NSAIDs, such as ibuprofen or naproxen, can reduce pain and inflammation. Acetaminophen can also alleviate pain, though it does not reduce inflammation. These medications are recommended for short-term use, typically no more than 7-10 days, due to potential risks to the stomach and kidneys with prolonged use.
Appropriate footwear is another self-care measure. Shoes should be supportive, well-cushioned, and offer a roomy toe box to avoid pressure on the tendons. Tight lacing patterns can exacerbate symptoms, so loosening shoelaces or trying alternative lacing can provide relief. Modifying activities that contribute to the pain, such as avoiding uphill running or excessive time on feet, can also aid recovery.
When to Seek Professional Help
While many cases improve with self-care, certain signs indicate the need for professional medical evaluation. Persistent pain that worsens or does not improve after several days of consistent self-care warrants a visit to a healthcare provider. An inability to bear weight on the affected foot is a significant symptom requiring immediate attention.
Signs of infection, such as redness, warmth, pus, or fever, necessitate prompt medical consultation. Numbness or tingling in the foot could suggest nerve involvement, which needs professional assessment. If there is significant swelling or a visible deformity on the top of the foot, seek a diagnosis from a doctor or physical therapist.
Professional Treatment Approaches
A healthcare professional typically begins with a physical examination to diagnose extensor tendonitis. This involves checking for inflammation, tenderness, and assessing the foot’s range of motion, sometimes including a resisted dorsiflexion test where pain indicates a potential tendon injury. Imaging tests like X-rays, MRI, or musculoskeletal ultrasound may be used to rule out other conditions such as fractures or torn tendons.
Physical therapy plays a significant role, focusing on exercises to strengthen muscles, improve flexibility, and promote healing. Therapists may guide stretching routines for the foot and ankle, along with strengthening exercises like calf raises or exercises using resistance bands. Manual therapy, which involves hands-on techniques to break up stiff tissue, and modalities like ultrasound or dry needling, can also be part of a physical therapy plan.
Prescription-strength NSAIDs may be recommended for pain relief if over-the-counter options are insufficient. Corticosteroid injections, which reduce inflammation, might be considered in some cases, although their use is limited due to potential risks like tendon weakening or rupture. These injections are generally avoided in certain tendons with higher rupture risk and are not a long-term solution.
Orthotics (custom or over-the-counter) and ankle braces can provide support and reduce strain on tendons by improving foot mechanics. For example, orthotics can help distribute pressure evenly, particularly for individuals with flat feet or high arches. Surgery is rarely necessary for extensor tendonitis but may be considered for chronic, severe cases that have not responded to at least six months of conservative treatments. Surgical options can include debridement, which cleans damaged tissue, or, in severe instances, tendon transfer.
Preventing Recurrence and Long-Term Care
To prevent recurrence and maintain foot health, wear proper footwear. This means choosing supportive, well-fitting shoes with good cushioning and a wide toe box, particularly for physical activities. Regularly replacing worn-out shoes ensures continued support and shock absorption.
Gradually increasing the intensity or duration of activities, especially when starting new exercise routines, helps prevent overloading the tendons. A guideline for athletes is to increase training volume by no more than 10% per week. Regular stretching and strengthening exercises for the foot and ankle muscles are beneficial for building resilience and flexibility.
Incorporating cross-training helps prevent repetitive strain by varying activities. Low-impact options like swimming or cycling can maintain fitness without stressing the foot. Pay attention to early signs of discomfort and address them promptly to prevent minor irritation from developing into a significant issue.