Extensor tendonitis is a common condition characterized by inflammation in the tendons that help straighten the fingers, wrist, or toes. These extensor tendons are located just beneath the skin on the back of the hand and wrist or across the top of the foot. This inflammation causes pain, tenderness, and sometimes swelling, which can significantly limit daily activities. Resolving this issue involves a multi-step approach, combining immediate self-care to calm acute pain with professional guidance and long-term changes to prevent its return.
Understanding the Condition and Causes
Extensor tendons are relatively exposed, especially on the back of the hand and the top of the foot, with minimal muscle or fat padding to protect them. In the hand, these tendons connect the forearm muscles to the bones in the fingers and thumb, allowing extension. On the foot, they attach the muscles in the front of the lower leg to the toes, facilitating toe lift during walking.
The primary cause of extensor tendonitis is repetitive strain or overuse, which places excessive friction on the tendon tissue. Activities requiring high volumes of wrist action, such as certain sports or manual labor, can strain the hand tendons. Improper form during exercise or work, or a sudden increase in activity without proper conditioning, also frequently leads to inflammation. For the foot, common culprits include wearing overly tight or ill-fitting shoes that press down on the tendons, or a dramatic increase in running mileage.
Immediate Self-Care and Acute Relief
The initial phase of treatment focuses on reducing acute pain and inflammation to allow the injured tissues to begin healing. This immediate response is centered around the R.I.C.E. protocol, starting with rest. Resting the affected limb means avoiding the specific activities that caused the pain, which may require temporarily modifying work tasks or pausing exercise.
Applying ice directly to the painful area helps to constrict blood vessels, reducing swelling and numbing the pain sensation. Apply a cold compress for 15 to 20 minutes at a time, repeating every few hours during the first 48 to 72 hours of acute pain. Compression, often achieved using an elastic bandage or supportive brace, helps to minimize swelling and provides gentle support to the inflamed area.
Elevation completes the initial management strategy, especially if swelling is noticeable in the extremities. Raising the affected limb above the level of the heart uses gravity to assist in draining excess fluid. Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can be used temporarily to manage both the pain and the inflammatory response.
Professional Medical Interventions
If self-care measures do not lead to significant improvement within a few weeks, or if the pain is severe, seeking professional medical intervention is necessary. A physical therapist plays a key role in a formalized treatment plan. They will initially use passive modalities like therapeutic ultrasound or electrical stimulation to manage pain and promote tissue healing.
Once the inflammation has subsided, the therapist will introduce specific, controlled exercises to restore flexibility and strength to the surrounding muscles. This often involves eccentric strengthening, where the muscle is lengthened while under tension, which improves tendon resilience. Mobilization techniques may also be used to improve the range of motion in the joint.
In cases where conservative treatments are insufficient, a physician may consider more targeted medical options. Corticosteroid injections deliver anti-inflammatory medication directly to the tendon sheath, offering pain relief. This approach is used sparingly due to the potential for temporary tendon weakening, which could increase the risk of rupture. Surgery remains a last resort, typically reserved for chronic cases where conservative treatment has failed for six to twelve months, or when mechanical issues require decompression or repair.
Strategies for Long-Term Prevention
Achieving a lasting resolution requires modifying the lifestyle and activities that initially caused the strain. Ergonomic adjustments are effective, particularly for hand and wrist issues related to computer use. This includes ensuring the keyboard and mouse are positioned so the wrist remains in a neutral, straight position rather than extended or bent.
For those with foot extensor tendonitis, prevention involves assessing footwear and activity habits. Wearing shoes that fit correctly, without excessive tightness over the top of the foot, is important to avoid constant pressure on the tendons. Individuals should also replace worn-out athletic shoes regularly to maintain proper cushioning and support.
Maintaining strength and flexibility in the muscle groups that support the affected tendons helps to distribute the load and prevent future overload. This involves a regular routine of strengthening exercises for the forearm or the lower leg muscles, depending on the location. Properly warming up before any strenuous activity and incorporating a gradual cool-down with gentle stretching are effective habits for maintaining tendon health and preventing recurrence.