Pain in your feet, no matter when or where, can be frustrating, especially if it seems like it came out of nowhere.  If there was trauma to the area, for example if someone stepped on your foot or something fell on your foot, then pain can be expected.  But when pain on the top of your foot is not from any trauma that you can remember, then there are a few things to keep in mind.  It could be due to a tendonitis.  What is tendonitis, you ask?  A tendon is the tissue that attaches the muscle belly to the bone.  In the top of the foot, there are several tendons that go from the muscle belly from the leg, across the top of the foot,  and attach to of each of the toes.  Tendonitis is inflammation of these specific tendons as they run across the top of the foot and insert into each one of the toes.  When you feel pain on the top of the foot, it can be due to the inflammation of these tendons form the extensor muscles, so this is often referred to on the top of the foot as extensor tendonitis. 

What Does Extensor Tendonitis Feel Like?  

Extensor tendonitis pain tends to be mild in the morning, then as the day goes on or the more you are on your feet, the more pain you feel.  It can be aching and sometimes red or swollen at the tops of the feet.  Activity aggravates this condition and rest makes your feet feel better.  It can feel like a pulling sensation on the top of your foot that may extend to the front of the ankles and if it travels to the actual muscle belly, you may feel it in the front of the bottom part of your legs. If it is due to shoes, then taking off your shoes or loosening your shoelaces may give you relief. 

How Did I Get This Type Of Tendonitis?

The top of the foot has very little fat between the tendons and the skin, and for this reason, sometimes decreased padding on the top of the foot in conjunction with tight shoes or tight lacing of the shoes can press up against these tendons.  The extensor tendons are responsible for pulling you toes up towards you, versus flexor tendons that allow you curl your toes downward.  With the flexing of the toes upward with each step you take, the tight shoes or shoe laces may be pressing up against and aggravating the tendon.  This in turn causes inflammation of the tendon, or a tendonitis.  If you evaluate your shoes and shoelaces and determine that is not the cause, then the cause can be biomechanical.  When there is a lack of arch support, the foot collapses and flattens out.  The extensor tendons need to work harder to pull the toes, and in turn the whole foot, up in basic gait.  This constant overuse of the extensor tendons that are used to pull the foot up in each step you take has an additive effect, and on the whole, will cause fatigue of the tendons and in the end swelling and pain.  

What Else Could It Be?  

It is important to rule out any bony issues that could be causing the pain.  If there is no bony abnormality, then this supports the diagnosis of a soft tissue problem, consistent with Pain on the top of the foot could also be due to trauma, it could be a stress fracture, or an arthritic process such as osteoarthritis or degenerative joint disease.  Each of these other diagnoses area treated differently.  That's why it is important to come into the office for a thorough exam and digital on-site Xray for an exam,  a treatment plan, and a proper diagnosis.  

How Can I Treat This Tendonitis?

The first step is to come to our office and have on of our doctors examine your foot.  We will also perform X-rays on site to rule out any bony cause for the pain.  Our X rays are taken weight bearing, or standing up, in order for our doctors to evaluate the structure of the foot and its bones an joints when there is the most pain.  We can review if and how the arch flattens out, or decreased, and how this may contribute to the diagnosis. The first thing to do is to decrease the pain and swelling and possible immobilization.  Immobilization can occur with a temporary soft cast, or unnas wrap, which you can wear with a shoe.  It is applied in our office, and it is specifically to decrease edema.  It also contains a soothing paste of zinc oxide to soothe the skin.  It is temporary and you remove it after a few days.  If not, then an ankle brace can be dispensed. The brace is special due the strapping that is used to immobilize the foot and ankle to support the tendons.  This way, the support can allow the tendons to prevent from being overworked and overstressed, and thus can heal.  In addition to immobilization, our doctors recommend MLS laser treatments to decrease swelling and pain. 

How Do I Prevent This Condition From Recurring?

Once the extensor tendinitis pain is gone, it is important to prevent it from returning.  The best way to do this is with custom orthotics. Custom orthotics are made by taking impressions of your feet, and these are sent to the lab.  Then, the orthotics are fabricated with specifications from a prescription by the doctors.  These custom orthotics are worn in your shoes and support your feet with every step you take.  The orthotics allow your tendons and ligaments to function biomechanically stable and prevent overworking of the tendons.  

If you have pain in your foot, remember, pain is not normal!  It is best that you call our office for an appointment with one of our doctors in order to find out what it could be.  The faster you come in, the faster our doctors can come up with a diagnosis and treatment plan and have you on your way to being pain-free.  


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