Extensor Tendonitis – Causes, Symptoms, Treatment & Exercise | Pain Care

Extensor Tendonitis – Causes, Symptoms, Treatment & Exercise

Inflammation of Extensor tendons of feet is commonly known as extensor tendonitis.

We could able to pull up the big toe and fingers of foot because of a muscle called extensor hallucis longus, which runs down from the knee to ankle over top of foot and divides in two part. One attaches to big toe while other part attaches to tips of the other fingers.

Tendon is nothing but a specialized tissues that connects muscles to the bone and fibrous in nature.

Most important functions of these tendons is to attach muscles to bone, provide stability foot bone and helping us to pull the toes in the upward direction.

As these tendons run across the top part of foot, tendonitis can be one of the cause for pain at top of foot.

Tight fitting shoes that creates pressure and irritation at top of foot may lead to extensor tendonitis.


Anatomical location of extensor tendons makes them prone to injuries, which lead to inflammation. This tendon runs from ankle to toes underneath the skin and above the bones of foot.

Constant pressure at the top of foot usually result in inflammation of tendons.

The most common causes of inflammation of extensor tendons are -

Poorly fitting shoes

Shoes that does not fit perfectly on feet and put pressure on top of foot causes inflammation of foot tissues including tendons which leads to tendonitis on top of foot.

Tight Shoelace

As like tight shoes, keeping shoelace too tight all the time also leads to tendon injuries.

So find a sweet spot while tying a shoelace, don't keep it too tight or too loose.

Altered Biomechanics of Foot

Good foot biomechanics are most important thing when it comes to healthy foot.

Disturbed foot biomechanics not only cause tendonitis but may result into multiple types of foot pain. In some cases it also result into altered posture.

Calf Tenderness

Calf tenderness can be due to variety of reasons. It can be caused by a simple injury to calf muscle, acute cramps, DOMS, or DVT.

Chronic calf muscle tightness may lead to tendonitis.

High Foot Arch

Having high foot arch or flat feet can also be a reason behind tendinitis.

Metatarsal stress fracture can also leads to the inflammation of tendons which is often called as metatarsal tendonitis.​


  • Top of foot pain.
  • Foot pain that worsen with movement.
  • ​Bruising, swelling and tenderness at top of foot.
  • Discomfort while walking.


If you are wondering how to treat tendonitis in the foot then be assured, as this condition can be treated successfully with rest, proper exercises and pills.

Foot rest

Foot is the most common area of our body that exposes to repetitive movement. In such condition like inflammation of extensor tendons, taking rest is inevitable.

Rest provides enough times to body to heal properly and reduces inflammation. Bed rest reduces stress on foot and tendons, giving them chance to recover fast.

Applying Heat or Ice Compression

Ice Application To Ankle

In acute conditions, ice compression can make wonders. Mayoclinic advice to apply ice compression in early stage of extensor tendinitis. [1]

Ice, work by anesthetizing local nerves of top of foot. It also help to reduce swelling of foot by constricting blood capillaries.

Ice compression must be applied only in early stage of tendinitis. Apply ice pack to affected area for 5 to 8 minutes. One can apply it every 6 hourly to get best results.

Repeat procedure for 2 to 3 days. [2]

Though ice compression can help in this condition, usually extensor tendinitis is a chronic disorder. So if you are experiencing pain since long time then ice compression will not help you.

Heat compression is useful in such scenario. Heat causes blood vessel to dilate, which increase blood flow to affected area and trigger speedy recovery.

Heat also act as local muscle relaxant.

Pay attention to Footwear

Good fitting shoes is crucial even though you are not suffering from any foot ailments.

A good shoes provide cushion to foot, comfort and may help to prevent certain foot conditions like tendinitis.

Before you buy a pair of shoes for yourself, consult your doctor to see if he can advice some personalized tips for you to chose a well fitting shoe.

Always opt for comfortable, well fitting shoe and avoid one that are too tight of bite to your feet. Tight shoes usually produce unnecessary pressure on feet that may result in tendonitis. Also never tie shoelace too tight.

But, the matter of fact that choosing a well fitting, comfortable shoe is a tedious work and one cannot recommend single brand to everyone as wearing shoes is matter of personalisation. (Because one size and shape does not fit to all)

It is hard to find a single shoe that can help everyone who suffers from tendonitis, Brooks made some good shoes that can help but these are not only the best shoes for extensor tendonitits.

soothing foot massage

Use soothing massage

Though it is not scientifically proven, in chronic conditions gentle massage across the top of foot may help to reduce pain.

Gentle massage improve blood flow of affected area and helps chronic tendinitis to heal better. It also helps to relieve pain.

Massage helps to stimulate natural repair mechanism of body that triggers healing.

How to massage for tendonitis?

Start slowly rubbing your fingers across the top of foot and gently rub the area. Always do the massage in perpendicular direction of tendons for better results.[3]


Physiotherapy helps to relieve tightness in foot and calf muscles & tendons by stretching them at regular intervals.

There are three most common stretches that can help in this conditions, that are pencil lifting, forefoot press & toe flexion.

Toe Flexion

​As name suggest this procedure starts by flexing your toes.

Means stand on feet and press the both toes in downward direction.

Hold this position for 5 seconds then repeat again for 5 to 10 times.

Forefoot Press

Keep back of foot on a 2 inch thick book while keeping front half on weighing scale.

Then slowly press front part of foot on weighing scale and keep increasing pressure until you can tolerate. Repeat this for 8 to 10 times.

This exercise put extensor tendon to work and help to strengthen them.

Pencil Lift Exercise

Seems simple but an effective exercise that only require a pencil as a tool.

To perform this stretch, keep pencil on ground and try to pick it up using your toe.

Once you pick the pencil hold it for 5 to 7 seconds, and then repeat the procedure for 10 times.

Watch this video for proper understanding of exercise -

Seek doctors advice

Yes, you need to see a doctor to get proper medication for your problem.

Doctor will take the history and provide anti-inflammatory medication as well as few other medicines that may be required in your case.

Tell the doctor exact condition of your foot and also provide history of allergy to medicine if you have any.

Doctor may ask you use some orthotics like shoe insole to provide support to your foot arch. This will relieve the tension in tendons to some extent.

Steroid injections

If everything fails to give you relief, doctor may recommend steroid injections to reduce pain and inflammation.

How to prevent extensor tendonitis?

Any tendonitis can be prevented.

  • Exercise regularly but avoid doing vigorous exercise that puts sudden pressure on tendons
  • ​Opt for exercise that helps to strengthen the muscles and tendons.
  • Pay attention to your daily activity that causes pain in joints of muscles. If possible stop doing them or take adequate rest between two activities that leads to pain.
  • Pay attention to your posture. Inadequate posture may lead to tendonitis.
  • Use shoes that fits comfortably to your foot.

References +

1 – http://www.mayoclinic.org/diseases-conditions/tendinitis/expert-answers/tendinitis/faq-20057872 (Link) 2 – Questions and answers about bursitis and tendinitis. National Institute of Arthritis and Musculoskeletal and Skin Diseases. http://www.niams.nih.gov/Health_Info/Bursitis. Accessed Aug. 25, 2014. (Link) 3 – Friction massage therapy for tendonitis by Paul Ingraham. https://www.painscience.com/articles/frictions.php (Link)

Extensor Tendonitis – Causes, Symptoms, Treatment & Exercise
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Extensor Tendonitis – Causes, Symptoms, Treatment & Exercise
Inflammation of Extensor tendons of feet is commonly known as extensor tendonitis. It can be acute or chronic & cause foot pain and discomfort while walking.
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Pain Care
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Dr. Sachin

Click Here to Leave a Comment Below 5 comments
Elle - September 3, 2016

Thank you for the helpful information.

Seems like pencil lift, forefoot press and toe flexion help a lot I am doing this my tendinitis since last few days and pain are reducing slowly. My doc also advised to change the footwear and to stay away from high heel.

I wasn’t aware that massage can be beneficial but any way gonna do it for few days now.

    Dr. Sachin - September 3, 2016

    Yes Elle, massage can be beneficial for some body pain but never rely only on massage. Seeking help from doctor is must for proper diagnosis and treatment.

Carla Nowag - September 3, 2017

Excruciating pain on right foot on left side and top of foot from big toe up to ankle. I have to holler when it happens. Wakes me up near morning but standing up has always stopped the pain. Since, yesterday getting up didn’t work at all! It was so bad I couldn’t put any pressure on right foot. Had to crawl or hop on one foot. Taking a prescribed muscle relaxer at night has worked for a month. I forgot to take it last night and that’s when my pain became unbearable. So, I took the pill for it 15 minute later. After 15 minute I could finally stand on it again,although I had to limp for about 6 hrs. I had bunion surgery 3 yrs. ago. It is now 3:A.M. and two pills later and no relief. I also have been taking codeine and Tylonel for 5 yrs. now for another pain problem. I am at my wits end!For the last two days though, I have been on my feet more than usual. A few yrs. ago I was diagnosed with facsiatist and nueropathy. I am not diabetic and never been.Is there any solution?

    Dr. Sachin - September 13, 2017

    Lots of going on for you. Have you recently visited your Doctor for this? If not, just have a visit and see if he ask for x-ray and few other tests to diagnose it properly, as taking muscle relaxant for a month is not good.

Doreen - November 26, 2017

I have been diagnosed with thickening of the EHL after injury to foot after fall. The foot also has foot drop, the fall occurred 10 months ago. No cause found, could the tendon injury and foot drop possible be linked.


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