Tendons attach muscles to bone to form an anchor and to assist in the muscle’s action. Extensor tendons are so-called because they assist muscles to extend a joint. There are extensor tendons in the feet, hands, wrist, knee and elbow. Extensor tendonitis is inflammation of a tendon, or the protective sheath surrounding a tendon, caused by forceful or repetitive movement.
Extensor tendons in the hand and the foot are similar in that they divide and spread over the back of the hand or the top of the foot to join onto the fingers or toes. In the feet, they help the muscles pull the foot up and are needed for walking and running.
Extensor tendonitis in the feet is a common injury among runners and those who play fast running sports. In the hands, the extensor tendons help to do several movements of the hand, wrist and thumb like grasping, twisting and extending.
While there are extensor tendons in the knee and elbow joints, which also have the similar function of extension of the joint, most cases of extensor tendonitis occur in the wrists, hands or feet.
Cause of Extensor Tendonitis
Extensor tendonitis is caused by over-use of an extensor tendon or by sudden force applied to the tendon or muscle. Sports or workplace activities that involve repetitive movements of extensor tendons are the most common causes although unaccustomed activity involving an extensor tendon can also lead to tendonitis.
Specific risk factors include:
- Runners and soccer players are prone to extensor tendonitis of the foot.
- Ill-fitting shoes or wearing shoes that are not specifically designed for the activity.
- Running or walking uphill, on uneven ground or slippery surfaces.
- Workers who do repetitive tasks especially if weight or force is involved.
- An activity that holds the hands or wrist in the same position for lengths of time.
- Unaccustomed use of the hands or wrists, particularly if force or weight is required.
- Swelling or redness at the site of the tendon. This is due to inflammation of the tendon.
- Pain which is usually worse with movement.
- In the foot, the pain and swelling will be along the top of the foot.
- The classic test for foot extensor tendonitis is to try and pull the foot up against resistance, which will cause pain along the top of the foot.
- In the wrist and hand, the pain and swelling will be along the thumb side or the back of the hand, depending on the tendons affected.
- Pain usually develops gradually.
- A snapping sound or sensation may occur when the joint is extended.
- Stiffness and reduced movement is often experienced.
Treatment of Extensor Tendonitis
- The primary treatment of extensor tendonitis is rest, by discontinuing the activity that was responsible for the injury. The joint should be rested until all signs of pain have disappeared; this could take several weeks, depending on the severity of the injury and how soon it is treated. It is important to allow sufficient time for the tendon to heal.
- Ice packs, applied every few hours for several days, are very effective at relieving the pain, swelling and inflammation. After you have returned to normal activities, it is a good idea to ice the affected area for a week or two, after you have finished the activity that was the cause of your tendonitis.
- Anti-inflammatory medication may help reduce the inflammation and relieve the pain. Some, containing aspirin or ibuprofen, can be purchased without prescription. Stronger anti-inflammatory drugs can be prescribed by your doctor if necessary.
- It sometimes helps to strap the hand or foot to isolate the area, which aids healing, and to reduce the possibility of sudden movements causing pain.
- After the pain begins to subside, it is a good idea to start with some gentle stretching exercise to prevent stiffness. If these hurt, stop and wait a few more days before trying them again.
- When you are ready to return to full activity again, do so gradually. If you feel pain, stop and rest the joint for another few days.
If these conservative treatments are not effective, your doctor may recommend cortisone injections or wearing a splint to further reduce movement.
There are preventative measures that you can take to avoid extensor tendonitis and to prevent the condition returning. The most important is to work within the limitations of your own body; only ever increase distance and intensity gradually and exercise to your own pace.
The following strategies will also help you prevent extensor tendonitis:
- Make sure you wear the correct shoes for the activity you are doing. Have them properly fitted by a trained sports shoes specialist.
- Avoid tying shoelaces too tight as this pressure can irritate the extensor tendons in the foot.
- Alternate activities and use some non-weight bearing exercise to rest the tendons.
- Wear cushioned shoes when you are going to be standing or walking all day at work.
- Always warm-up and stretch before you start any exercise activity. Pay special attention to stretching the extensor tendons and muscles.
- Take regular breaks when doing anything that involves repetitive actions of the hands or wrists. Change or alternate activities regularly, to avoid injury.
When doing repetitive tasks, try to keep the wrist in a neutral position.