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EXTENSOR TENDINOPATHY
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Background

Extensor tendinopathy is a condition that causes pain of the tendons along the top of the foot, which are responsible for flexing the foot and toes up. “Tendonitis” is a condition caused by inflammation, which is typically present in the first couple of weeks. If the problem is not addressed, then, after the first couple of weeks, the inflammation goes down, but the tendon begins to break down in a process called “tendinosis.”

The tendons involved include those of the muscles extensor hallicus longus, extensor digitorum longus, extensor halluces brevis, and tibialis anterior. The injury is commonly one of overuse but can be associated with excessive compression of the middle of the foot by laces that are too tight, or improperly fitting footwear. This condition is common in dancers, figure skaters, skiing, and runners.

Symptoms

Pain over the top of the foot, which can be accompanied by swelling. The pain can be worsened by running both uphill, due to the additional stress placed on the top of the foot, and downhill, which activates the extensor tendons as they lengthen (eccentric contraction). Numbness is not a typical symptom and should be considered a “red flag” as this could suggest a more serious condition (e.g. compartment syndrome).

Sports Medicine Evaluation and Treatment

The diagnosis is made clinically by reproducing the tenderness on exam; usually x-rays are not allowed, but in cases of persistent pain, advanced imaging, magnetic resonance imaging (MRI), may be obtained by a physician to exclude other conditions, such as a stress fracture.

Treatment

Conservative, and involves ice, rest, and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen. A rehabilitation program to strengthen the extensor muscles and promote ankle stability may be indicated. Surgery is rarely indicated except in cases of tendon rupture, which is uncommon, and presents with severe pain and weakness.

Injury Prevention

Care should be taken when changing shoe wear or increasing the intensity or distance of exercise, as this is a critical time that predisposes athletes to injury. Affected athletes should pay attention to persistent pain, and not wait long to have it evaluated.

Return to Play

Return to activity or sport is as symptoms tolerate. Padding under the tongue of running shoes, a change in footwear, or a change in shoe lacing pattern may prevent recurrence. Persistent pain should be evaluated by a medical professional to reduce risk of further injury.

AMSSM Member Authors
Jason Brucker, MD and Craig Young, MD

References
Barr KP, Harrast MA. Evidence-based treatment of foot and ankle injuries in runners. Phys Med Rehabil Clin N Am. 2005 Aug;16(3):779-99.
Pagenstert GI, Victor V, Hintermann B. Tendon injuries of the foot and ankle in athletes. Clin Ortho Trauma. 2004; 52(1):11-21.

Category: Foot and Ankle, Overuse Injuries,

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