Foot Pain: Is it Extensor Tendonitis or a Stress Fracture?

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Two of the most common causes of foot pain are extensor tendonitis and stress fractures. The similarities between these conditions can make it difficult to know which you have, and until you know what you are dealing with, you cannot properly treat it. Fortunately, there are differences you can use to determine what is causing your pain.

Stress Fracture vs Tendonitis

Extensor Tendonitis

Extensor tendons are tendons in your hands and feet that play an important role in their movements. People who spend a lot of time on their feet may develop extensor tendonitis of the foot, which is an inflammation of the extensor tendons. Wearing shoes that are too tight can increase your risk of developing the condition as well.

The primary symptom of extensor tendonitis is pain on the top of the foot often at the midpoint of the foot bones. Extensor tendonitis can develop in both feet, but in many cases, only one foot is affected. The pain produced by the condition tends to increase gradually as the tendon becomes more inflamed, and it may be relieved somewhat by activity, which stretches the tendon.

Stress Fracture

A stress fracture, also called a hairline fracture, is a tiny crack in a bone. It is typically caused by repetitive use and overuse. Runners and people like military recruits and hikers who carry heavy backpacks over long distances are especially susceptible to stress fractures.

The pain from a stress fracture is typically associated with a specific spot and may be minor at first, increasing over time. It tends to worsen with weight-bearing activities and lessen with rest. There may be swelling, bruising and tenderness in the area near the fracture.

Diagnosing and Treating Extensor Tendonitis and Stress Fractures

The easiest way to tell extensor tendonitis and a stress fracture apart is based on the pain. If it subsides somewhat with activity and gets worse when you rest, it is more likely to be extensor tendonitis. If your foot hurts more when you are bearing weight on it and feels better when you rest, a stress fracture is more likely the cause.

To treat extensor tendonitis, do the following:

  • Ice the area for 20 minutes at a time to help reduce the swelling.
  • Take a nonsteroidal anti-inflammatory drugs (NSAID) for pain relief.
  • Stretch your calf muscles, as tight calves put more strain on the extensor tendons.
  • In some cases, physical therapy may be needed to improve the condition.

To treat a stress fracture, follow what’s called the RICE method:

  • Rest (and minimize weight-bearing)
  • Ice (the affected area)
  • Compression (wrap the foot to minimize swelling, being sure you don’t inhibit blood circulation)
  • Elevation (spend time with your foot above the level of your heart to reduce swelling)

You can also use NSAIDs for pain relief.

With either condition, if it gets worse or does not improve with time and treatment, talk with your doctor. You should never try to “push through” an injury as that can lead to more damage and a longer recovery period.

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