Individuals with inflammation, pain, and swelling on the tops of their feet or hands could be experiencing extensor tendonitis. What treatment options are available?

Extensor Tendonitis

These tendons attach to muscles that straighten the fingers and lift the toes and the top of the foot. Extensor tendonitis is a condition characterized by inflammation of the tendons on the tops of the hands and feet. It often results from overuse of the muscles and from wearing tight shoes. Symptoms tend to worsen with activity and improve with rest. The condition does not usually require surgery; treatments include medications, home remedies/activity modification, and physical therapy.

Types

Tendonitis can develop in any tendon of the extensor muscles. These tendons are long, thin bands of tissue that can be felt on the tops of the hands and feet. The structures attach to muscles on one end and bones of the fingers and toes on the other. The extensor tendons in the hands include: (American Society for Surgery of the Hand, 2024)

• The extensor digitorum communis straightens the index, middle, ring, and small fingers.
• The extensor digiti minimi straightens the small finger.
• The extensor indicis proprius straightens the index finger.
• The extensor pollicis longus and extensor pollicis brevis muscles move the thumb into the thumb-up position.

Extensor tendons on the top of the foot attach to: (American Society for Surgery of the Hand, 2024)

• The extensor digitorum longus and extensor digitorum brevis muscles lift the second, third, fourth, and fifth toes.
• The extensor hallucis longus lifts the big toe.

Tendonitis vs Tendinopathy

• Chronic tendon pain can lead to a condition known as tendinopathy.
• Tendonitis results from inflammation.
• Tendinopathy is the degeneration/micro-tearing of a tendon that occurs with long-term overuse.
• Knowing which condition you are dealing with is important because it requires different treatments.

Symptoms

The primary symptom is pain in the affected tendon/s. Individuals may also experience swelling, and the skin can become red or warm to the touch. Extensor tendonitis can cause pain when using the affected muscles, moving the hand or foot in the opposite direction, and stretching the tendons. Usually, the pain worsens when using the affected muscles and improves with rest.

Causes

Extensor tendonitis in the hands usually results from overuse, which causes inflammation. However, it can also result from trauma, such as falling on the hand or an injury during physical or sports activities. Common activities include: (Hanson Z. C., and Lourie G. M. 2022)

• Manual labor work
• Typing
• Computer mouse use
• Weightlifting
• Gymnastics
• Playing a musical instrument

Extensor tendonitis in the foot can also result from overuse activities like running, especially uphill. However, it can also occur from wearing overly tight or tightly laced shoes for physical activities like running or dancing. Less common causes include: (Arthritis Foundation, N.D.)

• Medical conditions like diabetes or arthritis
• Medication side effects
• Infection
• Joint deformities

Treatment

Extensor tendonitis usually improves with conservative treatment, which includes self-care, activity modification, physical therapy, and medication.

Medications

Individuals can treat inflammation with non-steroidal anti-inflammatory drugs NSAIDs like:

• Ibuprofen
• Naproxen
• Aspirin
• Acetaminophen can help reduce pain.
• In some cases, individuals may need prescription anti-inflammatory medications like corticosteroids or pain relievers for short-term use.

Self-Care and Activity Adjustments

Self-care includes:

• Rest and avoid any activities that increase pain symptoms. If you can’t avoid them completely, take frequent breaks to allow the muscles to relax.
• Apply ice to the hand or foot several times daily for up to 20 minutes.
• Compression wraps should be applied on the foot or hand using an elastic bandage or soft splint to help support the injured tendons and reduce swelling.
• Elevate the hand or foot if swollen above the heart level when resting.

Activity Adjustments

• Modifying activities can help address the underlying cause/s.
• Hand extensor tendonitis can develop from poor positioning.
• Setting up an ergonomic workstation can help.
• Consult a coach or trainer if the tendonitis is related to sports or exercise.
• Individuals might need to adjust their technique or training schedule to decrease pressure on the tendons.

Physical Therapy

Physical therapy is an effective treatment. A therapy team can help determine the condition’s underlying cause and provide a personalized treatment program. Interventions can include:

• Pain-reducing treatments like ultrasound, electrical stimulation, electroacupuncture, and laser therapy.
• Manual therapy
• Massage therapies
• Targeted exercise programs
• Prescription of orthotics like a hand splint or shoe inserts.

Surgery

Surgery is not necessary unless the tendon is torn. (Bronner S., Ojofeitimi S., and Rose D. 2008) (American Society for Surgery of the Hand, 2014) Recovery after surgical repair requires physical therapy treatment following specific protocols based on the patient’s case.

Prognosis

Extensor tendonitis can take weeks or even months to fully heal. Early diagnosis and determining the condition’s underlying cause rather than just treating symptoms are recommended for a faster and optimal recovery. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop personalized treatment programs through an integrated approach to treating injuries and chronic pain syndromes, improving flexibility, mobility, and agility, relieving pain, and helping individuals return to normal activities. Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers if other treatments are needed.

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References

American Society for Surgery of the Hand. (2024). Tendons. https://www.assh.org/handcare/safety/tendons#Finger%20Extensor

Hanson, Z. C., & Lourie, G. M. (2022). Middorsal Wrist Pain in the High-Level Athlete: Causes, Treatment, and Early Return to Play. Orthopaedic journal of sports medicine, 10(4), 23259671221088610. https://doi.org/10.1177/23259671221088610

Arthritis Foundation. Foundation, A. (N.D.). Tendinitis. https://www.arthritis.org/diseases/tendinitis

Bronner, S., Ojofeitimi, S., & Rose, D. (2008). Repair and rehabilitation of extensor hallucis longus and brevis tendon lacerations in a professional dancer. The Journal of orthopaedic and sports physical therapy, 38(6), 362–370. https://doi.org/10.2519/jospt.2008.2749

American Society for Surgery of the Hand. (2014). Extensor tendon injury. https://www.assh.org/handcare/condition/extensor-tendon-injury#:~:text=The%20tendon%20may%20take%20eight%20to%20twelve%20weeks,may%20include%20stitches%20%28for%20cuts%20in%20the%20tendon%29.