Pain in the lower leg, especially when walking, often involves the extensor digitorum longus (EDL). This muscle is crucial for foot and ankle mechanics, making it prone to strain during daily activities. While shin splints are a common suspect, the EDL can also be a primary source of anterior lower leg pain. This article explains what the EDL is, why it causes pain during walking, and how to manage and prevent it.
Understanding the Extensor Digitorum Longus
The extensor digitorum longus (EDL) is one of four muscles in the lower leg’s anterior compartment, located on the outer side. It originates from the fibula, interosseous membrane, and tibia’s lateral condyle. Its long tendon extends down the leg, passing under the extensor retinaculum at the ankle, then dividing into four slips that attach to the four smaller toes (digits 2-5).
The EDL primarily extends, or lifts, these outer four toes. It also assists in ankle dorsiflexion, lifting the foot towards the shin. This dual action is important during walking, helping control foot mechanics, absorb impact, and assist in the “toe-off” phase. The deep peroneal nerve runs near this muscle; its entrapment can cause stiffness and pain.
Common Causes of Pain When Walking
Pain in the extensor digitorum longus during walking often results from undue stress on the muscle and its tendons. Overuse or repetitive strain, common in activities like increased walking, running, or cycling, is a frequent cause. Excessive stress without recovery can lead to inflammation (tendonitis) or tendon degeneration, causing localized pain, swelling, and reduced mobility.
Ill-fitting footwear is another factor. Shoes lacking support, cushioning, or laced too tightly can exert pressure on the EDL tendons, causing irritation and pain. Biomechanical issues like flat feet or high arches can also alter force distribution, increasing EDL strain.
Muscle imbalances also contribute. A weak tibialis anterior, which also lifts the foot, may cause the EDL to overcompensate. Tight calf muscles limit ankle dorsiflexion, forcing the EDL to work harder and increasing strain. These imbalances can lead to trigger points and localized pain.
While often mistaken for shin splints, EDL pain is distinct. Anterior shin splints involve overuse of dorsiflexor muscles, causing pain near the shin bone that worsens with activity. Chronic exertional compartment syndrome, where pressure builds within the anterior compartment, can also mimic EDL issues. This condition restricts blood flow to muscles and nerves, with pain typically subsiding with rest.
Relieving and Managing Pain
Relieving and managing extensor digitorum longus pain begins with self-care, often using the RICE protocol:
Rest the affected foot by reducing pain-triggering activities.
Apply ice packs for 15-20 minutes several times daily to reduce inflammation.
Use an elastic bandage for compression to minimize swelling.
Elevate the leg to reduce fluid.
Modifying activity levels is important. Temporarily reduce the intensity, duration, or frequency of walking or other activities to aid recovery. Avoid pushing through sharp pain, as this can worsen the condition. Gradually reintroduce activities as pain subsides to allow the muscle to adapt without re-injury.
Over-the-counter pain relievers can manage symptoms. NSAIDs like ibuprofen or naproxen reduce pain and inflammation. Acetaminophen also alleviates pain. Topical creams can provide localized relief. Always follow dosage instructions.
Choosing supportive footwear is important. Shoes with adequate cushioning, arch support, and a roomy toe box alleviate pressure. Loosening shoelaces, especially over the top of the foot, prevents irritation. Custom orthotics may provide additional support for biomechanical issues.
Seek professional medical advice if pain persists despite home treatment, worsens, or if other concerning symptoms develop. These include severe pain preventing walking, significant swelling, redness, warmth, numbness, tingling, or weakness. A healthcare provider can diagnose the cause and recommend a tailored physical therapy program.
Preventing Future Pain
Preventing future extensor digitorum longus pain requires consistent practices for lower leg and foot health. Incorporate proper warm-up and cool-down routines into physical activity. A brief warm-up (5-10 minutes of light walking) prepares muscles and reduces injury risk. A cool-down with a slower pace and gentle stretches aids recovery.
Regular stretching of lower leg muscles is important. Specific EDL stretches involve pointing toes backward or lifting the foot towards the shin. Calf stretches also address tightness that can strain extensors. Perform these gently, holding for about 30 seconds, avoiding bouncing.
Strengthening exercises for the lower leg and foot build resilience. Activities that improve ankle and foot stability, such as calf raises, single-leg balances, and resistance band exercises for dorsiflexion, support foot mechanics and improve muscle balance.
Gradually increasing activity levels is crucial to avoid overuse. Progress slowly over weeks or months, increasing walking distance or intensity by no more than 10% per week. This allows the body to adapt and strengthen, reducing strain on the extensor digitorum longus.