The four EDL tendons pass through the fourth anterior compartment under the extensor retinaculum and fan across the dorsum of the foot to insert into the extensor expansions of the four lesser toes. They extend the toes at both MTP and IP joints through the extensor expansions which receive contributions from the dorsal and plantar interossei and lumbricales. EDL tenosynovitis from overuse or shoe pressure produces dorsal foot pain.
Toe 2-5 extension and ankle dorsiflexion
EDL tenosynovitis under the extensor retinaculum produces dorsal ankle and foot pain reproduced by resisted toe extension. Extensor tendon adhesions from crush injuries or prolonged immobilisation restrict toe extension and produce a dorsal foot flexion contracture requiring tenolysis.
Dorsal ankle tendon sheath inflammation producing pain with resisted toe extension managed with activity modification and injection.
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