What is Extensor Tendonitis?
Extensor tendonitis is a more widely used term for what we should really be referring to as extensor tenosynovitis, which describes inflammation to the tendon and it’s surrounding synovial sheath (more on that here).
For the sake of this article however, I’ll be calling it extensor tendonitis, as this is the more widely recognised term in the running community!
Extensor tendonitis is an injury to the extensor tendons of the foot, which are joined to the muscles in the front of the lower leg. Overuse of the extensor tendons can cause inflammation and swelling of the tendons and the protective synovial sheath that surrounds each tendon.
While extensor tendonitis isn’t one of the most common running injuries, there is a pattern to be aware of; runners who do a lot of hill training, or have suddenly started doing more speed training are usually those who suffer with this type of tendon injury and foot pain.
The reason for this is that both uphill running and fast paced running requires a greater degree of active ankle dorsiflexion, meaning that muscles like tibialis anterior and the toe extensors (extensor hallucis longus and extensor digitorum longus) will find themselves working harder, putting more load on the extensor tendons.
Why do Runners Get Extensor Tendonitis?
There are various different potential causes of extensor tendonitis in runners.
These risk factors for extensor tendonitis include:
- Training errors (e.g. sudden increases in hill running, speed training, and/or running distance)
- Poor footwear selection: running in heavier shoes than usual, or shoes that create too much compression across the top of the foot and front of the ankle.
- Muscle imbalances around the foot, ankle and higher up the kinetic chain
- Poor foot and ankle biomechanics, or running technique
- Biomechanical compensations and weakness remaining from a previous injury, such as an ankle sprain
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What Does Extensor Tendonitis Feel Like?
Symptoms of extensor tendinopathy often include a progressively increasing pain on the front aspect of the ankle, and top of the foot, and pain upon ankle dorsiflexion (pulling your toes towards your shin).
Can You Run with Extensor Tendonitis?
I don’t recommend running with extensor tendonitis. You will recover from this injury more quickly with rest from running and rehabilitation exercises. If you must continue running, be sure to reduce your overall training load and stop running if your pain suddenly starts getting more severe.
While continuing to run with extensor tendonitis is usually painful, it is also quite possible. If your tendon pain follows the predictable and reactive pattern of becoming more painful after a run then settling quickly in the next 24-36 hours, it should be ok to run on… if you can handle the discomfort.
However, if your extensor tendon pain is getting progressively worse with each run, and takes longer to calm down after every run, you need to stop to let it rest and seek further medical advice. This pattern of progressive worsening may signal the start of degenerative changes occurring in the tendon, and the tissue entering a state of dysrepair.
Regardless, in both cases, your best option is to find a running specialist physio to assess your foot and ankle and devise a personal rehab and treatment plan for you to follow.
Dr. Christopher Segler shares some practical advice for running with extensor tendonitis in this video, and gives some steps you can take to help yourself recover faster:
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Extensor Tendonitis Exercises
There are of course exercises you can use to benefit your recovery from extensor tendonitis, both in progressively loading your tendons during the rehabilitation process, and working on the health of surrounding tissues.
These extensor tendonitis rehab exercises include:
- Foam rolling techniques for the muscles of the lower leg
- Calf stretching exercises (reduces load on the opposing dorsiflexor muscles)
- Weight-bearing ankle strengthening exercises
- The single-leg balance exercises from Stage 1 of our Free 30 Day Challenge
Best of luck with your recovery from this foot injury. Whether you choose to try and run with extensor tendonitis or opt to rest and give your ankle time to recover, be sure to listen to your body.
If in doubt, ask your physio!
