Brief Outline of Extensor and Flexor Tendinitis
The tendons attached to the muscles that are responsible for flexing and extending the toes and foot can become inflamed and irritated just like any other tendon. Overuse, tightness is opposing muscles, or foot deformities can cause this condition. Extensor tendinitis is more common that flexor, but flexor tendinitis tends to be more painful and debilitating. Dancers are most commonly associated with injury to this tendon group.
Anatomy and physiology
The extensor hallucis longus and extensor digitorum longus are the main extensor muscles of the toes. The tendons of these muscles run over the front of the ankle, over the foot and attach to the toes. These muscles dorsiflex the foot and work in opposition to the flexor muscles. When the calf muscles are tight, or the muscles are worked beyond their exertion level, inflammation of the tendon may occur.
The flexor group of muscles, the flexor hallucis longus and the flexor digitorum longus, have tendons that run down the inside of the ankle and under the foot, attaching to the toes. These muscles plantar flex the foot and toes.
Cause of Injury
Extensor tendinitis: Tight calf muscles, over-exertion of the extensor muscles, or fallen arches.
Flexor tendinitis: Repetitive stress to the tendon from excessive dorsiflexion of the toes.
Signs and symptoms
Extensor tendinitis: Pain on the top of the foot, pain when dorsiflexing the toes, some strength loss may be experienced.
Flexor tendinitis: Pain along the tendon, in the arch of the foot, and along the inside back of the ankle.
Complications if left unattended
Tendinitis when left unattended can cause strains to the attached muscle and could lead to a complete rupture of the tendon. The pain may become severe enough to limit all activity.
Rehabilitation and prevention
While resting the foot, it is important to identify the conditions that caused the problem. Stretching the calf muscles and the tibialis anterior muscle will help relieve the pressure on the tendons. Warming-up and gradually increasing workloads will help prevent tendinitis. Orthotics may be required when returning to activity to correct any arch problems.
Most people recover completely from tendinitis with simple rest and correction of the cause(s). In some rare cases, surgery may be required to reduce the pressure on the tendons and relieve the inflammation.