Extensor Tendonitis vs. Stress Fractures in the Foot


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’re dealing with, you can’t properly treat it. Fortunately, there are differences you can use to determine what is causing your foot pain.

What’s the Difference Between Tendonitis and a Stress Fracture of the Foot?

Extensor Tendonitis in the Foot

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.

What Does Extensor Tendonitis in the Foot Feel Like?

The primary symptom of extensor tendonitis is pain on the top of the foot, often at the midpoint of the foot bones (known as the dorsal). 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 that stretches the tendons in the foot. Because extensor tendonitis affects the tendons in your foot, you may notice that it becomes difficult to move or push off from your toes in certain activities, like dancing and running. Stretches and strengthening exercises that target these tendons will help you regain strength.

Stress Fracture in the Foot

A foot stress fracture, also called a hairline foot fracture, is a tiny crack in a bone. It’s 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 foot stress fractures.

What Does a Stress Fracture in the Foot Feel Like?

A stress fracture, usually occurring in the lower leg or foot, causes increased stiffness and muscle soreness. You can often detect a stress fracture in your foot because the pain is typically associated with a specific spot and may be minor at first, increasing over time. The spot will also be sore to the touch. The pain tends to worsen with weight-bearing activities, or the use of repetitive force, and lessens with rest. There may be swelling, bruising and tenderness in the area near the fracture.

In general, when you have a stress fracture, foot symptoms include:

  • Pain during typical daily activities
  • Swelling of the foot
  • Pain that lessens when you rest
  • Tenderness
  • Bruising

While having a stress fracture in the foot doesn’t mean you have to completely avoid walking or bearing weight on it, you’ll need to minimize your activity while the bone heals.

You can detect extensor tendonitis of the foot or a foot stress fracture, and tell them apart, based on the pain. If it subsides somewhat with activity and gets worse when you rest, it’s more likely to be extensor tendonitis. If your foot hurts more when you’re bearing weight on it and feels better when you rest, a stress fracture is likely to be the cause.

How Do You Treat Extensor Tendonitis or Stress Fractures in the Foot?

Whether it’s extensor tendonitis or a foot stress fracture, it can heal on it’s own. However, the following treatment options may help accelerate the process.

To treat extensor tendonitis in the foot, do the following:

  • Ice the area of the foot for 20 minutes at a time to help reduce the swelling.
  • Take a non-steroidal anti-inflammatory drug (NSAID) for foot 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 foot stress fracture, follow what’s called the RICE method:

  • Rest (and minimize weight-bearing)
  • Ice (the affected area of the foot)
  • 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 foot pain relief.

With either condition, if it gets worse or doesn’t 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.

Learn more about Orthopedic and Sports Medicine Services at Baptist Health.