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This book describes Extensor Tendonitis, Diagnosis and Treatment and Related Diseases

Today I have a 60 year old lady who consulted me about pain on top of her left foot for the past 1 month.
She complained pain in the 1st tendon of her right foot which was also swollen and hard.
There were particularly cramps in the foot when she flexes her toes upwards.
There was no history of injury but she does a lot of standing on her feet doing housework and looking after her dog and cats.
It was a clear case of extensor tendonitis of the foot.

Extensor tendonitis is a frequent disorder that produces pain across the top of the foot.

This form of foot tendonitis is produced by inflammation or irritation of the tendons that pull the toes up.

Normally, tendonitis of the extensor tendons happens caused by repeated friction across the top of the foot or excessive pressure from a poorly-fitting shoe.

Tendons are tough, fibrous connective tissues that attach muscles to bones.

The extensor tendons attach the muscles on the front of the lower leg to the toes.

They lift the toes upwards away from the ground.

The two main toe extensor tendons are:

1. Extensor Hallucis Longus which lifts up the big toe
2. Extensor Digitorum Longus which lifts the other four toes

Both tendons pass down across the front of the ankle, across the top of the foot and then fan out attaching to the tips of the toes.

The extensor tendons lie between the skin and the bones and there is little cushion around them, making them susceptible to injury resulting in ‘top of foot’ pain.

These tendons have an important function and are in vulnerable sites.

The most frequent cause is the overuse of the muscles, bones, and tendons in the feet.

In the feet, it is most often caused by:
a. Spending a lot of time standing (occupational hazard)
b. Wearing shoes that are too tight
c. Using inappropriate footwear for a sport or activity

There are a number of factors that raise the risk of developing extensor tendonitis in the foot:
1.Trauma or injury
(involved in an accident or dropping something heavy on the foot)
2.Poorly fitting shoes:
3.Tying one’s shoelaces too tight
4.Altered biomechanics of the foot
5.High foot arch or flat feet
6.Change in training methods
7.Running on ice/slippery surfaces

Pain at the top of the foot is a major symptom of Extensor Tendonitis
It is worsened by movement and intense physical effort
The stretching of the tendons can elicit a lot of pain
Diffuse swelling is also present over the top of the foot

There is a specific diagnosis test that can be conducted in order to make the final confirmation.
The doctor will ask the patient to pull the toes upward, fighting against the resistance.
If pain appears at the top of the foot or along the mid-foot it will be certain that the patient are suffering from extensor tendonitis.

MRI can give a better image of the tendons, muscles and other soft tissue

With proper rest and treatment with ice, there will be significant improvement for the patient to be able to start some light stretching and strengthening exercises within 7 to 10 days.

Other treatment is massage, NSAID, steroid injection, Platelet-rich plasma (PRP) treatment, shock wave therapy, tenex procedure and rarely surgery.

TABLE OF CONTENT
Introduction
Chapter 1 Extensor Tendonitis
Chapter 2 Causes
Chapter 3 Symptoms
Chapter 4 Diagnosis
Chapter 5 Treatment
Chapter 6 Prognosis
Chapter 7 Achilles Tendonitis
Chapter 8 Plantar Fasciitis
Epilogue