Extensor Digitorum Brevis Trigger Points

Introduction

The extensor digitorum brevis (EDB) is a small but important foot muscle responsible for extending the toes and stabilizing the foot during movement. When trigger points develop in this muscle, they can cause pain on the top of the foot and near the toes, often mimicking metatarsalgia, nerve compression, or arthritis.

Name and Area

  • Name: Extensor Digitorum Brevis (EDB)

  • Area: Located on the dorsum (top) of the foot, spanning from the calcaneus (heel bone) to the toes (digits 2–4).

Indications

Extensor digitorum brevis trigger points may contribute to:

  • Pain on the Top of the Foot (Mistaken for Nerve Pain or Arthritis)

  • Pain That Radiates Toward the Toes (Can Mimic Metatarsalgia or Morton’s Neuroma)

  • Tightness or Cramping in the Toes (Especially With Walking or Running)

  • Pain That Increases When Wearing Tight or Restrictive Shoes

  • Foot Fatigue or Weakness, Leading to Discomfort With Long Periods of Walking

  • Pain When Extending the Toes (E.g., Pushing Off While Walking or Running)

Pain from this muscle is often mistaken for nerve compression, foot arthritis, or metatarsal joint dysfunction.

Muscle Action

  • Extends the Toes (Digits 2–4): Lifts the toes upward.

  • Stabilizes the Foot During Walking and Running: Helps prevent excessive toe flexion.

  • Works With the Extensor Digitorum Longus: Assists in controlling foot dorsiflexion and toe movement.

The EDB is essential for smooth foot movement and weight distribution while walking or running.

Signs and Symptoms

Individuals with extensor digitorum brevis trigger points often report:

  • Pain on the Top of the Foot, Particularly Near the Toes

  • Difficulty Extending the Toes (Pain When Pushing Off While Walking or Running)

  • Burning or Tingling Sensation in the Foot (Mistaken for Nerve Pain or Neuropathy)

  • Pain That Feels Worse When Wearing Tight Shoes or High Heels

  • Cramping or Tightness in the Toes, Especially After Activity

Pain worsens with prolonged walking, running, or wearing tight shoes.

Perpetuating Factors

Common causes of extensor digitorum brevis trigger points include:

  • Wearing Tight or Narrow Shoes (E.g., High Heels, Cleats, or Dress Shoes)

  • Repetitive Overuse From Running, Sprinting, or Jumping

  • Foot Instability Due to High Arches or Flat Feet

  • Prolonged Standing or Walking on Hard Surfaces (Retail Workers, Runners, Hikers)

  • Toe-Curling Movements or Foot Strain From Certain Sports (Dancing, Ballet, or Soccer)

Trigger Point Referral Pattern

Trigger points in the extensor digitorum brevis refer pain to:

  • The top of the foot, especially near the toes

  • The dorsum of the foot (Can Resemble Nerve Pain or Arthritis)

  • The metatarsal region (Mistaken for Morton’s Neuroma or Metatarsalgia)

Pain from this muscle is often confused with nerve entrapment, arthritis, or overuse injuries.

Differential Diagnosis

Extensor digitorum brevis trigger points may be mistaken for:

  • Metatarsalgia (Pain in the Ball of the Foot, Often Worse With Walking)

  • Morton’s Neuroma (Pain Between the Toes With a "Pebble in the Shoe" Sensation)

  • Tarsal Tunnel Syndrome (Burning Pain and Numbness in the Foot and Toes)

  • Stress Fractures in the Metatarsals (Pain That Worsens With Impact Activities)

  • Peripheral Neuropathy (Tingling, Numbness, and Burning Pain in the Feet)

A thorough foot examination is necessary to rule out these conditions.

Associated Trigger Points

Extensor digitorum brevis trigger points often co-exist with:

  • Extensor Digitorum Longus (Pain in the Foot and Lower Leg, Affects Toe Control)

  • Tibialis Anterior (Shin and Foot Pain, Weak Foot Dorsiflexion)

  • Peroneus Longus and Brevis (Lateral Foot and Ankle Pain, Can Affect Balance and Gait)

  • Plantar Fascia (Arch Pain and Foot Stiffness, Often Related to Foot Overuse)

Anatomy and Innervation

Muscle Origin Insertion Innervation
Extensor Digitorum Brevis Calcaneus (Heel Bone) Middle phalanges of toes 2–4 Deep fibular (peroneal) nerve (L5–S1)

The EDB is innervated by the deep fibular nerve, which also controls toe extension and foot dorsiflexion.

Patient Examination

A comprehensive examination should include:

  • Palpation: Identify tender nodules along the top of the foot, near the toes and metatarsals.

  • Toe Extension Strength Testing: Assess pain and weakness when lifting the toes upward against resistance.

  • Gait Analysis: Look for abnormal foot movement patterns while walking or running.

  • Footwear Assessment: Determine if improper shoes are contributing to symptoms.

Corrective Actions

Manual Therapy

  • Trigger Point Release: Apply direct pressure to tight spots on the top of the foot.

  • Massage Therapy: Helps improve circulation and reduce foot tension.

Stretching

  • Toe Extension Stretch: Pull the toes upward gently while keeping the foot relaxed.

  • Foot Dorsiflexion Stretch: Stretch the top of the foot by pressing the toes down while standing.

Strengthening Exercises

  • Toe Raises: Strengthens the extensor digitorum brevis and foot stabilizers.

  • Resistance Band Toe Extensions: Improves toe control and foot endurance.

Postural and Footwear Adjustments

  • Wear Supportive Shoes With a Wide Toe Box

  • Use Custom Orthotics to Improve Foot Alignment

  • Avoid Excessive Barefoot Walking on Hard Surfaces

Summary Table: Extensor Digitorum Brevis Trigger Points

Field Details
Name & Area Extensor Digitorum Brevis; Top of the foot, spanning from the calcaneus to the toes
Indications Foot and toe pain, weakness in toe extension, discomfort while walking
Muscle Action Extends the toes, stabilizes the foot, assists in walking and running
Signs & Symptoms Pain on the top of the foot, difficulty extending toes, tightness in the foot
Perpetuating Factors Tight shoes, excessive running, foot instability, prolonged standing
Trigger Point Referral Dorsum of the foot, toes, metatarsal region
Differential Diagnosis Metatarsalgia, Morton’s neuroma, tarsal tunnel syndrome, stress fractures
Associated Trigger Points Extensor digitorum longus, tibialis anterior, peroneus longus/brevis, plantar fascia
Anatomy & Innervation Deep fibular (peroneal) nerve (L5–S1)
Corrective Actions Manual therapy, stretching, strengthening, footwear modifications

➡️ Learn more about Trigger Points

Sources:

  • Travell, J. G., & Simons, D. G. (1983). Myofascial Pain and Dysfunction: The Trigger Point Manual (2nd ed.). Williams & Wilkins.

  • Simons, D., & Travell, J. (1999). The Trigger Point Manual, Volume 2: The Lower Extremities. Williams & Wilkins.