Extensor Digitorum Longus Trigger Points

Introduction

The extensor digitorum longus (EDL) is a key lower leg muscle responsible for toe extension and foot dorsiflexion. When trigger points develop in this muscle, they can cause pain in the shin, top of the foot, and toes, often mimicking shin splints, foot arthritis, or nerve compression.

Name and Area

  • Name: Extensor Digitorum Longus (EDL)

  • Area: Located on the anterior lower leg, running from the tibia and fibula to the four lesser toes (digits 2–5).

Indications

Extensor digitorum longus trigger points may contribute to:

  • Pain in the Shin and Top of the Foot (Mistaken for Shin Splints or Stress Fractures)

  • Pain That Radiates to the Toes (Can Mimic Nerve Pain or Arthritis)

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

  • Foot Drop or Weakness in Lifting the Toes (Leading to Tripping or Dragging the Foot)

  • Pain That Increases When Walking, Running, or Wearing Tight Shoes

  • Aching or Burning Sensation in the Lower Leg After Extended Standing or Activity

Pain from this muscle is often mistaken for shin splints, peroneal nerve compression, or extensor tendinitis.

Muscle Action

  • Extends the Toes (Digits 2–5): Lifts the toes upward.

  • Dorsiflexes the Foot: Raises the foot, helping to prevent foot drop.

  • Assists in Foot Eversion: Helps rotate the foot outward slightly.

The EDL is crucial for proper walking and running mechanics, preventing toe dragging and improving foot clearance.

Signs and Symptoms

Individuals with extensor digitorum longus trigger points often report:

  • Pain in the Shin and Top of the Foot (Especially Near the Toes)

  • Difficulty Lifting the Toes or Keeping the Foot From Dragging While Walking

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

  • Pain That Feels Worse With Running or Walking Long Distances

  • Toe Cramping or Stiffness (Particularly in the Morning or After Activity)

Pain worsens with repetitive walking, running, or prolonged standing.

Perpetuating Factors

Common causes of extensor digitorum longus trigger points include:

  • Running or Sprinting Without Proper Foot Support

  • Wearing Tight Shoes or Cleats (Common in Soccer, Football, and Ballet Dancers)

  • Overuse From Sports That Require Quick Toe Movements (Tennis, Basketball, or Gymnastics)

  • Walking or Standing for Long Periods on Hard Surfaces

  • Foot Drop or Weak Tibialis Anterior (Leading to Overuse of the EDL to Compensate)

Trigger Point Referral Pattern

Trigger points in the extensor digitorum longus refer pain to:

  • The shin and top of the foot (Mistaken for Shin Splints or Stress Fractures)

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

  • The front of the ankle (Mistaken for Ankle Sprains or Tendinitis)

Pain from this muscle is often confused with nerve compression, stress fractures, or overuse injuries.

Differential Diagnosis

Extensor digitorum longus trigger points may be mistaken for:

  • Shin Splints (Medial Tibial Stress Syndrome – Pain Along the Inner Shin, Rather Than the Front of the Leg)

  • Compartment Syndrome (Severe Tightness and Pain in the Lower Leg That Worsens With Activity)

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

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

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

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

Associated Trigger Points

Extensor digitorum longus trigger points often co-exist with:

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

  • Extensor Hallucis Longus (Big Toe Pain and Foot Drop Symptoms)

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

  • Gastrocnemius and Soleus (Calf Tightness That Can Exacerbate Foot Weakness and Pain)

Anatomy and Innervation

Muscle Origin Insertion Innervation
Extensor Digitorum Longus Tibia, fibula, interosseous membrane Middle and distal phalanges of toes 2–5 Deep fibular (peroneal) nerve (L5–S1)

The EDL 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 shin, near the ankle, and on top of the foot.

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

  • Gait Analysis: Look for toe dragging or 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 along the shin and foot.

  • Massage Therapy: Helps improve circulation and reduce muscle tightness.

Stretching

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

  • Foot Dorsiflexion Stretch: Stretch the shin and top of the foot by pressing the toes downward while standing.

Strengthening Exercises

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

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

  • Tibialis Anterior Strengthening: Prevents overuse of the EDL in dorsiflexion movements.

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 Longus Trigger Points

Field Details
Name & Area Extensor Digitorum Longus; Front of the shin, spanning tibia/fibula to the toes
Indications Shin and foot pain, toe weakness, discomfort while walking
Muscle Action Extends the toes, dorsiflexes the foot, stabilizes the foot during movement
Signs & Symptoms Pain in the shin and top of the foot, difficulty lifting toes, tightness in the foot
Perpetuating Factors Tight shoes, excessive running, foot instability, prolonged standing
Trigger Point Referral Shin, top of the foot, toes, front of the ankle
Differential Diagnosis Shin splints, compartment syndrome, tarsal tunnel syndrome, stress fractures
Associated Trigger Points Tibialis anterior, extensor hallucis longus, peroneus longus/brevis, gastrocnemius/soleus
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.