From the Guidelines
Management of extensor tenosynovitis of the foot should begin with conservative measures, including relative rest, icing, and eccentric strengthening exercises, as most patients fully recover within three to six months with these treatments 1. The goal of treatment is to reduce pain and inflammation, promote healing, and prevent further injury. Key components of conservative management include:
- Relative rest of the affected area to avoid exacerbating the condition
- Icing to reduce pain and inflammation
- Eccentric strengthening exercises to promote tendon healing and strengthening
- Activity modification to avoid activities that aggravate symptoms
- Proper footwear with adequate support and cushioning to reduce stress on the tendons It is essential to note that while topical and systemic nonsteroidal anti-inflammatory drugs (NSAIDs) can provide acute pain relief, they should not be recommended over other analgesics due to potential side effects 1. Injected corticosteroids can also relieve pain but should be used with caution due to the risk of tendon weakening 1. Surgery should be reserved for patients who have failed conservative therapy, typically involving tenosynovectomy to remove inflamed synovial tissue. Addressing the underlying cause of tenosynovitis, whether overuse, improper footwear, or inflammatory conditions, is crucial to prevent recurrence. By prioritizing conservative management and addressing the underlying cause, most cases of extensor tenosynovitis can be effectively managed, reducing morbidity, mortality, and improving quality of life.
From the Research
Management of Tenosynovitis in Extensor Tendons of the Foot
- The management of tenosynovitis in the extensor tendons of the foot can involve various approaches, including non-operative and operative methods 2, 3.
- Non-operative management may include the use of nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy, immobilization with splints, and rest 4, 5.
- In some cases, corticosteroid injections may be used to reduce inflammation and relieve pain 6.
- Operative management, such as tenosynovectomy, may be considered in cases where non-operative treatment is unsuccessful or if there is a significant impingement or other underlying condition causing the tenosynovitis 2, 3.
- The specific management approach may depend on the underlying cause of the tenosynovitis, as well as the patient's overall health and activity level 5, 3.
Specific Considerations for Extensor Tendons of the Foot
- Pyogenic tenosynovitis of the extensor digitorum longus tendon is a rare condition that can occur in the absence of trauma or other underlying conditions 2.
- Talar head impingement can cause extensor digitorum longus tenosynovitis in individuals who participate in high-impact activities, such as ultramarathon running 3.
- A thorough evaluation, including imaging studies and clinical examination, is necessary to diagnose and manage tenosynovitis of the extensor tendons of the foot effectively 4, 2.