Have you been having pain in your ankle? More specifically, have you had pain in the front of your ankle? Is there pain when you are walking or running when you are lifting your foot up? Does it hurt when you are walking up stairs? You may be suffering from extensor tendinitis.
Tendinitis is a condition in which there is inflammation and associated pain in a tendon. There are several tendons throughout the ankle and foot. The extensor tendons are those in the front of the ankle running onto the top of the foot. Some of these tendons extend just a bit beyond the ankle joint, while others span all the way to the tops of the toes. All of these tendons assist in lifting the foot off of the ground with walking and/or running. They work extra hard when going upstairs as well.
Extensor tendinitis, as with many other types of tendinitis, is caused by overuse of the tendon. Overuse is most often related to your foot structure in combination with activity type and extent. With extensor tendinitis, we also see a great number of cases whereby the overuse is actually due to compensation for another condition. This means that you may have previously been experiencing pain from another condition and then walk differently to accommodate for this and in so doing, aggravate the extensor tendons.
If your foot pain started in one location and has moved to the front of ankle/top of foot area and extensor tendinitis is suspected to be a component of the issue, it is important to address this. In some instances, it can mean that your treatment plan will be slightly different in order to account for supporting the now painful extensor tendons.
As with any tendinitis, the goal of treatment is to reduce inflammation (and therefore secondarily this will reduce pain) and also to provide support to the ankle so that the overuse can reduce. We see patients frequently with heel pain due to plantar fasciitis. In these cases, some people are guarding to reduce the amount of pressure they place on the heel to avoid pain and allow them to keep walking. If your body’s preferred way to guard is through using the extensor tendons then eventually you can notice pain, tightness and swelling to the front of the ankle or top of the foot. We also have a lot of patients who experience extensor tendon pain because they primarily are suffering from arthritis on the top of the foot.
For patients with a flexible foot structure, the bones along the top of the arch may contact each other more closely. This happens as the foot flexibly flattens on with standing and ultimately this causes pain, swelling, inflammation and often bone spur formation on the top of the foot. To stop the excess motion, our extensor tendons will fire more and for longer, resulting in fatigue and pain and tendinitis.
Initially with extensor tendinitis, use of durable medical equipment is important as it immobilizes the painful area and supports to foot so that those extensor tendons can ‘rest’ while you are walking – or at least take off some of the strain. In many cases, the tendinitis will improve in a matter of weeks and then we carefully wean out of the assistive device and back into normal activities. If the pain doesn’t improve, MRI and ultrasound can be very helpful in determining if there is something more than inflammation in the tendon – namely a tear or thickening.
Icing and anti-inflammatories assist in reducing pain and improving the condition. Another great treatment is MLS laser. This laser helps to mediate and reduce inflammation and also provide analgesia – without the use of oral medication. The laser essentially lets your body know that there is an area in need of repair and helps to stimulate healing. MLS laser is non-painful and can be recommended for either 6 or 12 sessions. In cases where the tendinitis is acute (meaning it has been present less than 4-6 weeks) 6 sessions may be sufficient. Cases in which the tendinitis has been going on more than 6-8 weeks, or has been flaring up on occasion over the course of months or years, 12 sessions is necessary.
EPAT is another advanced modality offered at our office which helps to re-start the healing process when it comes to tendinitis and injuries. This treatment is less comfortable to have performed than laser, but it has been shown to offer great benefits. With EPAT, there is a handpiece that provides pulsed sound waves into the tissue. It feels like a large rubber band being snapped against the skin repeatedly. As the session continues, there is usually a numbing effect to the overlying area. With subsequent sessions, our patients are able to tolerate a higher level of energy which continues to stimulate healing in that particular part of the body.
Extensor tendinitis rarely results in a need for surgery. If a surgical procedure is recommended, it may be in the case of a tear or it may be related to the underlying cause of compensation. If the tendon is torn, it may require repair surgically with surgical grade sutures (stitches) and at the same time, removal of damaged tissue may be performed. If the underlying cause of tendinitis is compensation from painful arthritis, removal of bone spurs or even some fusions between bones may be necessary.
Regardless of how long or through what means the condition resolves, we ultimately recommend custom orthotic inserts. The benefits are many with this treatment. It is conservative and the purpose of these custom inserts is to correct foot structure and optimize the way in which the tendons of the foot function. When there is underlying arthritis and in cases where the foot structure is somewhat flexible, the orthotic helps reduce how much the arch collapses and reduces impingement on the top of the foot.
If you are suffering from pain in the front of your ankle and/or the top of your foot, you may have extensor tendinitis. To have a clear picture of your condition and start feeling better, call soon! The longer you wait, the more difficult and complicated it can be to get back to what you love comfortably.