Toe tendonitis in both feet

Hi, I am a 25-year-old female and I have developed tendonitis in the toes of both feet after a pedicure (mostly both big toes).

It has been going on for almost two months.

Although over the past few years I have developed a history of chronic ankle sprains and tendonitis (always linked to the injury, usually subsides in a few months with proper care), I have had numerous pedicures done before and never had any prior sensitivity in my toes.

Furthermore, I was relatively pain-free and healthy at the time of my pedicure. (This had only been the case for several months however, as I sprained my left ankle a year ago and residual tendinitis and weakness lasted for a while.)

This pedicurist was really rough with me, however, and was handling my feet improperly.

When she was filing my toenails, she was twisting my toes back and forth in a direction that would sprain them (a.k.a. not up and down and or side side, but twisting them rather hard).

I did not say anything at the time-- although I did not like how rough she was, I never had toe problems before and didn't realize or register that she was truly injuring me.

After the pedicure, my right foot really hurt, and the next day it became swollen and bruised.

I was told I probably had one or more sprains in the toes of that foot, as well as broken blood vessels and bruising.

I decided to go on crutches because the pain in my right foot was too severe. My left foot had been slightly achy after the pedicure (in an abnormal way), but I had totally normal range of motion and was not experiencing pain upon weightbearing).

The soreness in my left foot was barely noticeable to me, probably because I was too preoccupied with the swelling and pain in my right.

One week later, when I was stretching my left foot in bed, I felt a sharp pain on the ball of my big toe, as if I had pulled a tendon. (I was bending my left toes back and forth to compare the normal range of motion in them to my right foot.

At first I thought maybe I hyper-extended it.) I continued to weight-bear on my left foot only for about half of the day, but the pain was too bad so I stayed off of it as much as possible, partially weight-bearing on both feet through the crutches only when walking was necessary.

All of a sudden, my left foot became the sorer foot and my right foot, though still sore, could handle partial weight-bearing or a little full weight-bearing. My physical therapist, who knows my feet pretty well, told me that my left foot was probably injured during the pedicure but I did not notice it right away, and the pain was brought out because it was compensating for my right foot too.

So, I continued to do partial weight bearing through the crutches on both feet for another week and a half.

I then started to go off the crutches for short distances (like going to P.T., the swimming pool, or bike rides) and began some part-time summer work (which only required sitting, but getting there and leaving was difficult enough for my feet).

I had some slight ups and downs, but basically things were not getting much better or worse. My gait was rather stiff, especially because I had a hard time pushing off of my left toes. This continued for about 4 weeks. Last week it was feeling a little better (but by no means all better) and I increased my activity a little more--going out to the coffee shop, swimming,
and furniture shopping.

Still, my activity level considerably less than "normal." During the furniture shopping, I was wearing new shoes with rocker soles called "MBT's."

I thought they would really help because they would enable me to walk without pushing off my toes directly, but instead I probably walked too much on my heel and my extensor tendons in my left foot killed the next day.

At my PT session the next day, my PT said that the nagging pain probably means my tendons need more rest. So, I decided to just stay off my feet for a bit. And that's what I've been doing for the past 5 days. I quit my part time summer work, and I've basically been finding adoptive ways to do everything without using my feet--which usually means crawling.

I don't know if this is the right solution--I hope to work my way up to partial weight-bearing within a week or so. I have used the stationary bike a little and done non-weight bearing exercises.

I'm really worried because I've never had both feet injured before like this and I don't know how I'll recover since both legs are becoming atrophied.

I planned to strengthen my right leg and use the crutches with it, but it hurts too much so I could not even go to PT yesterday, which really helps me. Maybe I should rent a wheelchair. On top of all this, I'm supposed to be moving and starting grad school in a month.

Luckily, my boyfriend is moving with me and he is currently receiving unemployment so he will be available to drive me around and help out whenever I need it, at least for the first month or so.

But at this rate, I don't know if this will be enough. I have a teaching fellowship and will probably lose my stipend or have to reapply if I need to take medical leave.

I'm no stranger to foot injuries, but this is of a proportion that I'm not used to. Whenever I have recovered, I have really depended on my good leg to help me through (i.e. shifting weight on it when standing for long periods, etc.)

I also tend to take a little extra time and injuries become further aggravated if I work through too much pain-- I graduated from college a semester late and backed out of a new job due to tendonitis related injuries (triggered by sprains).

I know the whole ice, massage, rest, exercise as tolerated protocol, but this is not working quickly enough for me. I've actually been using an ice bucket on my own because it ices my toes more effectively, and I've done a little bit of ice massage but not to the extent that you recommend. I tried it this morning and I think it will help some.

I tend to do more self-massage, but I have to be careful not to overuse my wrists and hands. I guess my main question is this-- do you think it is a good idea to rest it completely or will it make harder when my activity level dramatically increases in the fall?

A little more about me-- I never had any foot injuries or pain until about four years ago. I used to be an avid runner and hiker, but now I try to to rely more upon biking, yoga, swimming and walking for exercise.

I eat very healthy but I may not get enough protein since I often eat vegetarian. I wear custom orthotics and start to develop pain if I go without them for too long. I have high arches and the doctors have told me I am hypermobile.

Joshua Tucker, B.A., C.M.T.
The Tendonitis Expert

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Jul 13, 2009
PART 2 - Toe Tendonitis in Both Feet
by: The Tendonitis Expert

Joshua Answers:

Wow, that's a lot of foot pain. That's no good.

I'm not going to pretend to have all the answers from here (it would obviously help to see your feet in person), but I have a few thoughts from what you have said.

1. That's a lot of sudden tendon pain. It makes me curious.

2. Bone Broth as the best Tendon Supplements.

If you can swing it within a vegetarian context, I would highly recommend starting to regularly eat home made bone broth.

I don't know what your diet consists of, or if you're a 'good' vegetarian or a 'bad' vegetarian, but it makes sense to me that you could be seriously lacking some vital nutrition on a variety of levels.

If I make some assumptions about the dietary habits of mostly vegetarian 25 year old recent college graduates.....

I would really start bolstering your nutrition/diet to bolster your body's ability to keep itself whole and strong.

Home made bone broth, and raw organic milk if you can find that anywhere.

That's my #1 long term suggestion.

3. How have you been icing? Ice Dipping frequently for 10-20 seconds, or leaving it in for several minutes.

Either way should help, but if you have chronic acute inflammation, I would take a day off, get some movies, and Ice Dip both feet 100 times for 10-20 seconds each. And by 100, I mean A LOT and ALL DAY.

You need to OVERWHELM the Process of Inflammation.

That's my #1 short term tendonitis pain and tendon inflammation suggestion.

4. Hypermobility can certainly play a role. How hypermobile are you? Can you bend your thumb to touch the side of your wrist? When you straighten your elbow, does it hyperextend?

5. How would you describe your overall health?

6. Do you have a tan? Do you spend time getting exposure to the sun? I bet that you are Vitamin D deficient, and that plays a huge role in a lot of things, including tendon pain.

Check out the Vit D deficiency pages on

7. Rest does not heal Tendonitis. Period. Not how you want it healed. And it doesn't really take the pain away either, because you have to get around, and you do that on your feet.

8. Describe in more detail how you self massage too.

Joshua Tucker, B.A., C.M.T.
The Tendonitis Expert

Jul 17, 2009
PART 3 - Toe Tendonitis in Both Feet
by: Anonymous

Thanks for your answers!

I have been doing ice dipping and ice massage and I can definitely notice a slight decrease in pain. (It's still up and down at this point). I also am going to try the bone broth--it makes a lot of sense.

I talked to my physical therapist, and he thinks that I'm still dealing with ligament damage too, which makes the injury more serious and complicated than just straight-up tendonitis. Especially since it could potentially be all of my toe ligaments that were sprained, and he says it takes one year before they completely return to normal. (He thinks I've developed a little bit of tendonitis too, from overuse/improper use immediately following the injury.) Ligaments do need rest, so he says I need to be the judge of when I'm ready to push forward more.

To answer more of your questions, I am not ridiculously hypermobile. I cannot touch my thumb to my wrist and I am not double jointed. All my life, people always comment how flexible I am when I stretch. When I do a toe touch, I can reach way past my toes. I can do splits, and in yoga I can do the "pretzel poses" that people think or so amazing. Stuff like that-- I could never be a contortionist or anything. I never labeled myself as "hypermobile" until a few years ago, when the podiatrist was explaining why I was prone to ankle sprains.

My overall health is fair-- when I'm fully recovered from injuries I'd say it is good to excellent, but injuries too often set me back for me to stay feeling "strong." I exercise regularly, although I'm not too intense usually. Up until a few years ago, I exercised all the time and I was extremely active and outdoorsy. I never had a serious injury till I was 21, but now it seems to be a cycle. I'm conscious of my health and diet, but I allow myself some indulgences too.

I have a slight tan and I definitely get outdoors--I love being in the sun although I try not to overdo it. When I self-massage, I'm usually trying to get the extensor and flexor tendons, since the soreness has spread through the arch of the foot and top of the foot--I don't really rub the actual toes because they're very delicate and sensitive right now. I sometimes use my knuckles so I don't overwork my fingers. I just recently started using a home ultrasound too, since it was helping when my PT did it and I'm still not getting over there yet.

Thanks again for all your advice--I find it very helpful. I'm excited (kind of!) to try the bone broth, and I'd appreciate any other feedback.

Jul 24, 2009
PART 4 - Toe tendonitis in both feet
by: The Tendonitis Expert

Yep, keep at the icing, both ice dipping and ice massage.

If it's 'ligamentitis', they share the same issue that tendons have, meaning 'indirect blood supply'.

That's why they heal so slow. The more blood you can get to them, the faster they will heal. Literally.

First, get the pain out and keep it out. You'll have to ice a lot at first, to overwhelm the Inflammation Process.

You may have to do this for a good long while to support your body in it's healing.

It's not very fun or sexy advice, but it's the best option you have, in my opinion, at this point.

Plus Bone Broth. You need all that nutrient, and a lot of it.

Keep me updated. It will take effort, but you can do it. It definitely beats the alternative.


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