The small muscles running down the front of the leg below the knee are known as the extensor muscles. The extensor hallucis longus, or EHL, and the extensor digitorum longus, or EDL, are the two main muscles in this group; their tendons cross the ankle and insert into the toes. Together, the extensor muscles bring the toes and foot up toward the shin, in direct opposition to the larger calf muscles, which point the toe. According to the Mayo Clinic, tendonitis occurs when the tendons, or cord-like attachments of muscle to bones, become inflamed and irritated, usually due to overuse.
According to "Ramamurti's Orthopaedics in Primary Care," treatment of any tendonitis should start with a rest period, resting the affected foot as much as possible and avoiding activities that stress the extensor tendons, such as running on hills and stair climbing. The Mayo Clinic suggests ice and NSAIDS to help alleviate swelling. For best results, the ice pack should be placed on top of the foot between the ankles over the spot of tendon irritation, and used several times a day.
According to "Therapeutic Exercise: Foundations and Techniques," by Carolyn Kiser and Lynn Allen Colby, massage can play an important role in healing inflamed soft tissues like tendons. When the tendons are still tender, gentle massage to reduce localized swelling in the foot is indicated. As tolerance increases, cross-friction massage may prevent scar adhesions from forming, which can significantly reduce motion later.
Stretching and Strengthening
The Podiatry Network cites tight calf muscles as one of the leading causes of extensor tendonitis. While tight calves are common in athletes such as runners, regular stretching helps to build flexibility and prevent irritation to the extensor tendons. Wall stretches for the large gastrocnemius muscles and step stretches for the smaller soleus muscles typically work well. Once the initial period of irritation and pain ends, gradual strengthening of the extensor muscles is indicated.
Sometimes, extensor tendonitis may be caused by a flat foot, a condition that occurs when the normal arch of the foot falls. When this happens, it puts additional strain on the extensor muscles during activities using the legs. In these cases, the Podiatry Network suggests using shoe inserts or orthotics to correct the flattened arch and restore normal biomechanics to the foot and leg.
When cases of extensor tendonitis don't heal with rest, nonconservative measures might be needed. The most common involves a steroid injection into the tendon sheath. While this can alleviate swelling, according to "Ramamurti's Orthopaedics in Primary Care," caution is necessary to avoid causing tendon rupture.