What is that lump on my achilles?

Do you have an unusual lump in your achilles? Often this is painful and tender to squeeze. In some cases this lump can appear after trauma or a sudden stretch or jarring.

• So what is it?

  Obviously we need to exclude many other possible diagnosis it often presents as a tendonosis or achilles tendonitis.

  The Achilles tendon connects the calf muscles to the heel bone or the calcaneus. It controls the lifting up of your body weight onto your toes and is one of the most active tendons in the body especially when you are walk or run.

  So whats the difference between tendonitis and tendonosis:

  • Achilles Tendinitis. This actually means “inflammation of the tendon.” But inflammation is rarely the cause of tendon pain.
  • Achilles Tendinosis. This refers to tiny tears (microtears) within and around the tendon. These tears occur due to overuse, poor biomechanics, or trauma. This often causes a painful lump.  The term tendonitis is sometimes used across the board, however,  it is very important to differentiate between the two as the management can be quite different.
  • The achilles tendon also sustain a partial or completely tear (rupture). A partial tear may or may not cause symptoms. A complete rupture is easier to diagnose and causes pain and instant loss of muscle activation.

  The achilles is a common problem that we see and in many cases it can be due to repeated trauma or poor biomechanics.

Achilles tendinopathy occurs more in people older than 30. Ruptures usually occur between the age of 40-50 who are often social athletes when the tendon has been loaded beyond its functional capacity.  It commonly happens on rapid acceleration or deceleration such as running for a drop shot in tennis or between wickets in cricket. A rupture of the achilles will result in surgery and a 6-12 month intensive rehabilitation process.

In some cases we have seen that swelling will lead to weakness in the tendon and calf and predispose someone to a spontaneous. Similarly if someone has an underlying weakness or biomechanical issue that has resulted in a rupture they are often at risk of rupturing the other achilles unless corrected.

At Physica Ringwood some of our team are trained at imaging of the tendon to explore the difference between achilles pain.Te image below was taken in November 2014. The image on the left shows the swelling of the tendon which was widened by 4mm compared with their opposite side.

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The management of achilles tendonopathy involves many of the following: management of the tissue changes (occasionally non steroidal anti inflammatory medication, strengthening programs, tendon loading exercises, biomechanical analysis/correction, orthotics,  and localised soft tissue therapy.

The use of the GaitScan^R is an important tool in understanding the forces going through the feet and ankles during walking and running. In the athletic population we will also perform a biomechanical analysis of their running or indivdual sport. We choose to use Ubersense ^R  for this.

Image from Ubersene.com

AVOID STRETCHING– stretching your calfs is often not the best thing to do and can irritate

WEAR A SMALL HEEL/LIFT: this will upload the tendon

ICE CUBE MASSAGE

SEEK TREATMENT: our physiotherapists will perform a biomechanical assessment as well as provdie local treatment to the area using several differnet modalities and manual therapy to reduce pain and promote healing. Our team will also write the ideal rehabilitation program that has been clinically shown to assist in tendon remodeling and speed up the recovery.

WEAR SUPPORTIVE SHOES/ORTHOTICS

CARE WITH FOOT POSTURE- in many cases your foot posture such as how your rest it under a chair, driving a car or sleeping will affect your Achilles. Our team will advise you in more detail.

Click on the list icon to open up the ability to dissect, xray or see cross sections of the achielles