Tendons are bands of tissue that connect muscles to bones. The extensor tendons connect the bones in the fingers to muscles in the back of the hand that help to straighten the fingers and thumb. In the feet, they connect the bones of the toes to the muscles in the front of the legs.
- The skin covering the extensor tendons is very thin, and there is little muscle or fatty tissue to protect them.
- Tendons are often in a frequently-used part of the body
- These two factors make them very susceptible to injury.
- There is a lot that can be done to prevent extensor tendonitis, including strengthening exercises and rest.
Extensor tendons connect muscle to bone in the hand and foot, and extensor tendonitis is commonly caused by overuse.
The most common cause is overuse of the muscles, bones, and tendons in the feet or hands.
In the feet, it's most often caused by:
- spending a lot of time on the feet
- wearing shoes that are too tight
- using inappropriate footwear for a sport or activity
In the hands, the most common cause of extensor tendonitis is doing an activity that uses the hands and wrists in a repetitive motion such as:
- prolonged or high impact typing with a non-ergonomic keyboard
- practicing or playing an instrument, such as piano or guitar, excessively
- regularly playing sports that stress hands and wrists, including baseball or racquetball
Mallet finger is a common type of injury that occurs to the fingers, especially in athletes. It occurs when the tip of the finger is struck hard, such as with a ball, which injures the tendon that runs along the top of the finger.
Without treatment, the tendon can become permanently damaged, causing the tip of the finger to fail to straighten completely.
Symptoms and diagnosis
The most common symptom of extensor tendonitis, whether it occurs in the foot or the hand, is pain. In the feet, the pain is usually localized to the top of the foot, usually close to the center of the foot. In the hands, pain tends to occur on the top of the hand.
Other symptoms of extensor tendonitis include:
- redness, warmth or swelling near the injury
- increased discomfort with activity
- crepitus, which is a crunchy feeling or sound over the affected tendon
- stiffness of the joint
Diagnosing extensor tendonitis usually requires a physical exam and history with a physician. The doctor will ask questions about the pain and other symptoms.
Common questions are about whether anything makes the pain better or worse, the history of the symptoms, and if anything triggered the discomfort.
Sometimes, the doctor will order an X-ray or magnetic resonance imaging (MRI) test to get a detailed look at all the bones, muscles and tendons around the injury. These images can help the doctor look at the structures around the pain to see where the damage is and if there is another cause for the symptoms.
Anti-inflammatory medication, such as ibuprofen, may be recommended by a doctor if rest does not alleviate the pain.
Injuries to the hands and feet are common and usually resolve within a few days with basic care at home.
However, if the pain doesn't start to improve after a couple of days, or a person experiences swelling, redness, warmth or other symptoms, they should visit their doctor.
There is a range of treatment options available for extensor tendonitis.
Rest and relaxation
Resting the affected joint is crucial, especially if the tendonitis is caused by overuse. It is essential to stop the activity that is causing the pain until the tendon has healed, to prevent further injury. In less serious cases, rest may be all that is needed until the tendon has healed.
In some cases, the doctor may recommend anti-inflammatory medications, such as non-steroidal anti-inflammatory drugs (NSAIDs), such as acetaminophen or ibuprofen.
Sometimes, a stronger medication, such as a steroid, is needed instead.
Finger or toe splints
Mallet finger may require splinting for several weeks so that the tendon returns to its previous position and completely heals in place.
It is important to clarify with the doctor about the length of time that the finger must remain in the splint. It is common to have to wear the splint continuously, even in the shower.
Removing the splint and moving the finger before the tendon has healed, could reinjure the tendon.
Extensor tendonitis of the foot may require physical therapy and special stretches for a tight calf muscle. Also, some orthopedic surgeons or podiatrists will recommend the use of a splint or orthotic shoe inserts.
Surgery to repair extensor tendonitis is rare and usually reserved for very special or unique cases. If considering surgical repair of the extensor tendons, people should ensure they see a surgeon who has experience performing these types of procedures.
Prevention and recovery
When engaging in activities it is recommended to wear the correct shoes to prevent injury.
Extensor tendonitis in the hands and feet can be prevented by:
- wearing shoes that support the feet and ankles
- wearing the correct shoes when doing an activity
- taking breaks while performing repetitive activities that aggravate the injury
It's important to pay attention to how the hands and feet are feeling, and make adjustments as needed. Avoiding or adapting an activity that is causing pain is important.
Someone who has surgery to repair extensor tendonitis may have a longer recovery period and may require rehabilitation or physical therapy in order to regain full function.
As with any surgery, there is the risk of infection, bleeding, or other complications. Individuals should speak to the surgeon about potential problems before surgery.
The prognosis of extensor tendonitis is excellent; in most cases, a person with this condition makes a full recovery without any lasting problems in the affected joints. How long it takes to recover depends on how severe the tendonitis was, and how well a person managed it.
For example, a person who rests properly will recover more quickly than someone who "pushes through" and continues to use the affected joint.
Although it can be painful, extensor tendonitis is a fairly preventable and easily treatable disease. It is important to see the doctor with any pain, especially in the hands or feet.
Quick diagnosis and treatment is the key to minimizing tendon damage and recovery.