From the Guidelines
Foot extensor tendonitis from overuse requires a combination of rest, anti-inflammatory measures, and gradual rehabilitation, with the primary goal of reducing morbidity, mortality, and improving quality of life. The most recent and highest quality study 1 recommends relative rest and reduced activity to prevent further damage and promote healing and pain relief.
Key Recommendations
- Reduce activities that aggravate the condition, particularly those involving repetitive foot movements
- Apply ice to the affected area for 15-20 minutes several times daily, especially after activity, as cryotherapy provides acute relief of tendinopathy pain 1
- Gentle stretching of the foot and ankle can help, including toe raises and ankle circles performed 2-3 times daily with 10-15 repetitions each
- Proper footwear with adequate arch support is essential; consider adding cushioned insoles or orthotics if needed
- Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can be used for short-term pain relief, but have no effect on long-term outcomes 1
Treatment Approach
The treatment approach should focus on reducing pain and inflammation, promoting healing, and gradually reintroducing activities while monitoring symptoms. Eccentric strengthening is an effective treatment of tendinopathy and may reverse degenerative changes 1. Topical NSAIDs are effective and may have fewer systemic side effects.
Monitoring and Follow-up
If symptoms persist beyond 2-3 weeks despite these measures, consult a healthcare provider as physical therapy or other interventions may be necessary. Surgery is an effective option in carefully selected patients who have failed three to six months of conservative therapy 1.
Quality of Life
The goal of treatment is to improve quality of life by reducing pain and inflammation, promoting healing, and gradually reintroducing activities while monitoring symptoms. By following these recommendations, patients can expect to improve their quality of life and reduce the risk of further complications.
From the Research
Foot Extensor Tendonitis from Overuse
- Foot extensor tendonitis is a type of tendinopathy that can occur due to overuse or repetitive strain on the tendons in the foot 2.
- The development of tendinitis and tendinopathy is often multifactorial, resulting from both intrinsic and extrinsic factors, including mechanical overload and improper form and equipment 2.
- Tendinopathies of the foot and ankle, including posterior tibial, peroneal, and tibialis anterior, are commonly overlooked by primary care physicians, and can present with pain, deformity, and limited mobility 3.
Treatment Options
- Nonoperative treatment options for foot extensor tendonitis may include support for the medial longitudinal arch, physical therapy focusing on eccentric exercises, and immobilization 3, 4.
- Surgical treatment may be considered for patients who do not respond to nonoperative treatments after three to six months, and is based on the specific stage of tendinopathy 3.
- Rehabilitation regimes for extensor tendon injuries, such as static splintage, interphalangeal joint mobilization, and the "Norwich" regime, have been compared in prospective trials, with varying results 5.
Risk Factors and Prevention
- Varus hindfoot is a known risk factor for peroneal tendinopathy, and lateral ankle sprains can be a contributing factor to the development of foot extensor tendonitis 3, 4.
- Proper form and equipment, as well as gradual progression of activity, can help prevent overuse injuries and reduce the risk of developing foot extensor tendonitis 2.