What is Extensor Tendonitis?

Extensor tendonitis is an inflammation of the extensor tendons—the tendons that run along the top of the foot and the back of the hand. These tendons are responsible for lifting the toes and fingers, extending the wrist, and helping the ankle flex upward. When they become irritated or overused, they swell and cause pain, making everyday activities like walking, typing, or gripping objects uncomfortable.

Causes

Extensor tendonitis usually develops from repetitive strain or pressure on the tendons. Common causes include:

  • Wearing tight or poorly fitting shoes that press on the top of the foot

  • Overuse injuries from running, especially uphill or on uneven surfaces

  • Repetitive hand motions such as typing, playing instruments, or manual labor

  • Direct trauma (dropping something on the top of the foot or hand)

  • Foot structure issues like flat feet or high arches, which increase tendon strain

  • Underlying conditions such as arthritis, gout, or autoimmune disease

Symptoms

Typical symptoms of extensor tendonitis include:

  • Pain on the top of the foot (often under the shoelaces) or the back of the hand

  • Pain that worsens with activity and improves with rest

  • Swelling, warmth, or redness over the tendon

  • Stiffness or difficulty moving the toes, fingers, or wrist

  • Tenderness when pressing on the affected tendon

  • A sensation of tightness across the top of the foot or hand

Diagnosis

Diagnosis is usually straightforward and involves:

  • Medical history and physical exam – checking for tenderness, swelling, and pain with resisted movement

  • Movement tests – such as resisting toe or finger extension to reproduce pain

  • Imaging – X‑rays to rule out stress fractures; ultrasound or MRI if tendon tears or other injuries are suspected

Nonsurgical Treatment

Most cases improve with conservative care. Common treatments include:

  • RICE protocol – Rest, Ice, Compression, Elevation

  • Footwear changes – loosening laces, switching to wider shoes, or adding padding

  • Orthotics or shoe inserts to reduce tendon strain

  • Anti‑inflammatory medications (NSAIDs) for pain and swelling

  • Physical therapy – stretching, strengthening, and correcting biomechanics

  • Activity modification – reducing repetitive motions or high‑impact exercise until healing occurs

  • Corticosteroid injections – occasionally used for persistent inflammation

When is Surgery Needed?

Surgery is rarely required for extensor tendonitis. It may be considered only if:

  • Symptoms persist for 6 months or longer despite nonsurgical treatment

  • There is a tendon rupture or severe structural damage

  • Scar tissue or chronic degeneration prevents normal tendon function

Surgical options may include tendon debridement (removing damaged tissue), tendon repair, or tendon transfer in severe cases. Recovery usually involves physical therapy to restore strength and flexibility.