Extensor Tendonopathy Tendinopathy

Tendinopathy is a comparatively new term, which is used to denote both tendonitis and tendinosis collectively. Both these conditions lead to pain and swelling on the upper surface of the foot.

Tendonitis refers to the inflammation of the tendons (the strong fibrous extensions of the muscles that attach them to the bones). Inflammation is the process by which the body protects itself against damage from trauma, stress or infections.

Tendinosis, on the other hand, refers to a deterioration/weakening of the tendon, micro tears occur in the tendon tissue that fail to heal and lead to pain and disability.

In the initial stages of tendinosis, there may also be inflammation. However, usually tendon pain is the result of tendinosis (tendon injury) rather then tendonitis (inflammation).

The extensor tendons of the toes are actually the fibrous extensions of the muscles that are located on the front side of the lower leg and help to extend the toes. There are two main extensor tendons: the extensor hallucis longus tendon (extends the big toe) and the extensor digitorum longus tendon (extends the four small toes).

Both the tendons pass in front of the ankle and travel along the upper surface of the foot, finally inserting into the toe bones. These tendons extend the toes during walking or climbing.

Causes of extensor tendonitis or tendinopathy:

Tendinopathy can occur as a result of:

Acute injury

Overuse injury

Overexerting the tendons, such as excessive running, especially running uphill or downhill as the tendon has to work hard to control the foot. Running on icy surfaces also puts stress on the tendon.

Degenerative changes in the tendon that can be due to ageing or other factors

Tight calf muscles, which pose greater resistance to the action of extensor tendons

Fallen arches

Ill-fitting shoes, especially shoes that hurt the top of the foot

Mostly the extensor tendon of the big toe is affected; inflammation of the extensor tendon of the small toes is uncommon.

Symptoms:

There is pain and swelling on the upper surface of the foot (along the course of the tendons)

The area is also tender to the touch

Activities that stress the tendon such as running and climbing uphill or downhill, aggravate the pain

Pain intensifies when the toes are extended against pressure

Diagnosis:

Although symptoms point towards the problem, the condition can be confused with metatarsal stress fractures, which are also quite common in athletes and runners.
X-rays help to rule out any fractures, although they do not confirm tendon pathology.

CT scan and MRI are better diagnostic tools for tendonitis.

Treatment:

The initial treatment involves resting the inflamed tendon and relieving pain.

Avoiding stressful activities, cold therapy and anti-inflammatory drugs help to control pain and swelling. Though anti-inflammatory drugs are not very useful in resolving tendinosis.

The actual treatment depends upon the cause of the problem.

Calf muscle stretching helps to reduce the stiffness of calf muscles and reduce stress on the extensor tendons.

Using padding in the forefoot area helps to relieve pressure

Innersoles to help support the foot and rest overworked tendons – these are often strained when the foot over-pronates

Using insole devices to correct faulty biomechanics, such as using arch supports

Strengthening the extensor muscles also improves their resistance to overuse injury and inflammation

Ultrasonic massage therapy is also helpful in accelerating the healing

Wear comfortable shoes; do not tie up laces too tightly

For tendinosis, as the main problem is failed healing, there are certain new treatments which promote healing by increasing platelet activity in the area (platelets have growth factors that can help in new tendon growth). These include needling the affected tendon to promote bleeding and thus platelet activity, or by injecting a person’s own blood or platelets (derived from the blood) in the area.

It should be remembered that tendon injuries are slow to heal, therefore it is important that a proper healing period be provided. Surgery is rarely indicated.