Extensor Tendinopathy

If you trace your finger over the top of your midfoot, from one side to another, you may feel the tops of the thin extensor tendons that run across the top of the foot, starting around the ankle where they connect to the extensor muscles, and moving to connect to various bones of the toes and midfoot. These tendons are collectively known as ‘extensor’ tendons because of their primary action - to help lift (dorsiflex) the foot and toes towards the sky, which is essential when walking to help your feet stay clear of the ground so you’re not prone to regular tripping and falling. Your extensor tendons also help control and stabilise your feet when you’re moving, and support your balance.

When the extensor tendons become damaged and painful, such as from being overworked, this is known as extensor tendinopathy. Extensor tendinopathy feels like pain across the top of the foot, which may be felt anywhere from near the ankle to the midfoot or even toward the base of the toes. Depending on the extent of the damage, the pain can range from mild to severe, and may feel sharp or dull. In many cases there is also some swelling at the top of the foot, particularly in the early stages. You may notice your foot feeling weaker or stiff, and it may be more difficult to lift your toes.

While extensor tendinopathy can sometimes affect both feet, you’re more likely to experience it in just one foot - and it’s likely to be your leading or dominant foot. As you continue to push through and use your feet without treating the problem, the pain at the top of your foot is likely to gradually get worse, and you may start to feel more weakness in the affected foot.

Like any of the tendons in your body, your extensor can only take on so much load and strain before they reach their limit and damage occurs. The most common mechanisms of damage are overuse through repetitive movement such as in running and jumping sports, direct injury to the foot and tendons such as during a fall or dropping something heavy on top of your foot, and through degeneration and weakening over time which is often associated with the natural ageing process.

Other factors that may contribute to overloading and the development of extensor tendinopathy include:

• Suddenly changing the intensity of your training or the type of training you’re doing, such as switching to uphill running for prolonged periods from flat track running
• Wearing ill-fitting or unsupportive footwear, or an incorrect lacing technique that puts undue pressure at the top of the roof
• Muscle tightness, or weakness that may be related to historical injuries
• Foot posture problems, such as having flat feet  or high arches
• Poor running or training techniques
• Not giving your body enough time to recover between training sessions
• Medical conditions such as inflammatory arthritis can also contribute to extensor tendinopathy

If you’re experiencing pain at the top of your foot, start by limiting movements and activities that aggravate your pain as well as any tight fitting shoes that press on the top of the foot to help you get some temporary relief. You can also try:

• Icing your foot (through a towel or cloth to protect the skin) for no more than 15 minutes at a time, four times per day. This may help reduce your pain and inflammation.
• Keeping your foot elevated and rested where possible - keeping your foot elevated above heart level can help reduce swelling and promote healing, and resting helps prevent further damage while your damaged tendons are still vulnerable.
• Using a compression bandage or sleeve over the foot to help reduce swelling and support the foot
• Using non-steroidal anti-inflammatories to help you manage any pain and swelling

Here at Matt Raden Podiatry, our trusted and experienced podiatrists listen to the concerns, goals and needs of our patients with extensor tendinopathy, and utilise a range of evidence-based treatment methods to help you get the best outcome. Our goal is not only to make you comfortable now, but to understand the root of the problem so you can exercise and stay active without being held back by foot pain.

Every appointment starts with a comprehensive assessment to uncover the causes of your foot pain, which includes analysing your gait, testing for muscle imbalances, assessing joint stiffness or tightness, analysing your foot posture and alignment, and more. We’ll then create a tailored treatment plan based on the results. This may include:

• Orthotics (insoles): as issues with foot posture and alignment can result in added stress on the extensor tendons, where indicated, our podiatrists can prescribe custom foot orthotics that will work to add the right support to the foot to help optimise your recovery. Your orthotics will also keep your foot in an ideal and stable position, helping reduce your painful symptoms.
• Footwear recommendations: there are various factors of your shoes that we need to consider when treating extensor tendinopathy - not just their fit, the tightness over top of your foot and your lacing technique, but also things like the weight of your shoes, which will naturally increase the strain on your extensor tendons. 
• Activity modifications: in order to optimise your recovery, we need to ensure the activities you’re doing are supporting your healing, and not placing excess pressure on your extensor tendons and hence making your injury worse. We may suggest some modifications to your existing training routines and techniques to achieve this.
• Strengthening and stretching program: muscle weakness and tightness can both play a role in the development of extensor tendinopathy, as well as in delays in healing and its recurrence. Depending on the results of your assessment, we may recommend some physical therapy to best support your joints and muscles.
• Gait retraining: we may work with you to help retrain your gait and work on your technique to address biomechanical issues that may be contributing to your pain and injury.

Immobilisation: in severe cases of tendinopathy, a boot or walker may be required to help immobilise the foot and allow the tendons to begin healing and repairing effectively.