Lump question

Hello Every one,

I have a question/concern. When I run my finger or hand across my injured/recovering tendon, I feel a slight lump/bump where the tendon is connected to the Calf and another one where the tendon is connected to the heel. This has been there I believe since week 2, the size of the lump is reducing, its not eye visible and it doesn’t generate pain. However, over the last 10 days, I don’t think I have seen any progress on that. My orhto checked the repair site yesterday and he didn’t mention anything about and I forgot to ask.
I’m in two shoes indoors, do you guys think this deserves shceduling a visit to ask about that or getting it checked or I’m over reacting ? I have searched in the blog for answers and there are some contradicting answers, some people say it was a sign of overuse and some people say its normal or a scar issue.
Due to my work commute, I do about 7000 steps per day. Is that too much? The Doctor said its Ok, but I’m still quite nervous.

Appreciate your answers!!

17 Responses to “Lump question”

  1. Bumps really could be so many things. I’d advise keeping an eye on them and if you’re that worried call to ask the doc if they think you should be seen about them.

    How many steps a day should you do? As many as you can tolerate without causing painful swolleness. For some it may be 7000, for others only 4000…who knows? It’s individual. I use a pedometer and I am up to 8000 - 10000 before my tendon feels sore, but that’s my tolerance number of steps. Understand the concept?

  2. Thanks Donna…

    I asked the physician assistant about the lump on the top of the tendon she said they make a knot during the surgery and that was it :D But when I started noticing the lower lump, I got concerned. I think I will call and ask especially that I’m a week away from meeting with PT.

    Yup, I think I do understand the concept of the steps and I agree with you.. What is always nerving to me is the concept of overuse (What does it really mean) without noticing or having pain.. But maybe I should trust my body a little bit.

  3. I will tell you that I had that same “bump” just below my calf muscle and my PT thought it was where one of the calf muscles had atrophied to the point where it looks like a bump. He said it was actually the atrophied soleus muscle. I’m not sure but at 16 weeks and several workouts/therapy sessions under my belt, that bump is no longer there. The bump you described at the lower part of your leg sounds like the site where they may have performed the actual repair to the tendon but I’m not sure in your particular instance. I still have mine (at the lower part of the leg where they made the repair) and have been told this never really goes back to normal.

    I wouldn’t worry too much about it - my Dr. told me that a person’s unique anatomy can cause all kinds of bumps and lumps to form as they’re recovering. Good luck with your continued recovery.

  4. I know what you mean Mousta by “what does overuse really mean”…it’s relative to each persons tolerance to discomfort. I know for me it means I’ve done to much when my tendon is really sore and I just don’t want to be up and about anymore. It happens less and less as time goes by. I think it’s different for everyone. If you’re not having any pain…YAY THAT!

    Cj you said: ” …Dr. told me that a person’s unique anatomy can cause all kinds of bumps and lumps to form as they’re recovering.” Yes mine said the same thing. I have two bumps one on the bottom related to the repair where he tied the knot in my permanent sutures and one at the top (not near the calf muscle) that he thinks is a blocked lymphnode with some fluid built up. The tendon at the repair site is tender and hypersensitive at both bumps and between these two bumps. I use a topical medication to address it and I am being fitted now for shoes with a Orthotist because the bottom bump if under pressure or friction from shoes is too uncomfortable to walk.

    From my research some people’s bumps never bother them, some like mine are hypersensitive and do bother us.They are not entirely certain why some repair site scars are painful. Most likely it’s nerve damage. I am told it will go away over time, maybe in a few weeks or maybe not until over a year? Who knows. I also know my tendon at 24 weeks now has changed shape and size and I am told it will continue to do so. My approach is to address it by doing what I can to minimize the tenderness overall.

  5. Hey guys i am 22 weeks post op and i have a small bump on the bottom of my incision, which is about an inch above where the tendon connects to the heel bone. It does not hurt but there is discomfort when I wear hightop basketball shoes. I dont get much swelling but this bump started forming around 19 weeks. My bump is also tender and does not matter how much i massage and ice, it is not going away. I am not too worried about it right now because there is no pain. I have been running hard and doing sprints at about 80%. I still am not close to doing a proper single heel lift (come off ground approx 2 cm)..strange because i have been doing box jumps about 2 feet off the ground with no problem. would like to hear how you guys are doing…i wouldnt worry about the bump just monitor it and make sure it dosent get any worse.

  6. Andrew, calf raises come over time and from my observations that date is all over the place in these blogs (I’ve seen 16 weeks to over a year). It surprises me that many can never even do them after a year. I’m thinking that is due to improper rehab or not being compliant and actually doing the rehab…or they have healed even slightly long. Not long enough to really be noticeable but long enough so that they can get some strength back but not full strength, not enough to hold their body weight….if over time you can not do a calf raise it could be due to the inability to build calf strength but since you are doing rehab and are compliant in trying to build it, that Inability to build the calf could be that you healed slightly long. Don’t wish that for you. Hope you continue to progress.

  7. Donna…I was concerned about healing long and I’m hoping that is not the case. How are you doing with calf raises?

  8. Andrew…I started with an eccentric heel drop program (not raises) at 16 weeks and when I mastered that I began a concentric heel raise program and just reached my goal of 3×15 unassisted twice a day, am 25 weeks this week.

  9. Can you guys explain to me what is healing long ?

  10. Mousta thanks for letting us hijack your post!

    If the Achilles tendon is too long it can’t modulate the work that the calf muscles do so we can walk and so forth. The tendon is a force modulator so to speak….imagine a fan belt in a car or any motor, if it’s too loose it doesn’t work properly. If the tendon is too LOOSE it won’t work properly and it makes it hard to say build calf muscle up. It is not common according to my OS. He said our suturing techniques today are so good even under stress they won’t allow the tendon to give enough to heal long especially when combined with NO stretching or even ROM exercises until the healing phase at 6 weeks is over. But that’s him. His protocols do call for weight bearing anytime after week 3 when in a boot. Controlled weight bearing is not stretching and that is one of the reasons we wear the boot…it helps us to bear weight without stretching the tendon…that’s why at first we wear wedges or used hinged boots to control that stretch. This is why you do not go from your cast to a boot in neutral position. Unless you go form the cast to the boot at week 6, some docs think that is beyond the time too much stretching to make the tendon too loose could occur and at that point may put you in a boot at neutral…There is not a lot of research on this and much of it is open to debate as others think the tendon can “get elongated” beyond 6 weeks and there should be no stretching until after 12 weeks, that even means walking which is why some protocols have you in a boot until week 12. Do you understand now?

    Please anyone who can explain it in another way feel free…this is my understanding and may be incomplete and as such, I’m willing to be corrected or have my explanation made clearer.

  11. Actually I can already correct myself…big smile. The Achilles doesn’t so much modulate or regulate force as transmit force.

    I’d suggest everyone with this injury read up on how the tendon works as well as how it heals. Just the basics will do if you’re not a science geek educator like me. Learning these things helped me greatly to understand what happened when my rupture occurred, what is and has been happening within my body as it heals and I go through rehabilitation, not to mention how it helps me understand why the protocols are as they are and why they vary so widely. YAY for LEARNING new things! Keeps me young.

  12. Thanks Donna for the explanation.
    This is quite scary and Im getting nervous about that.
    I read a little about it in TomTom, he had a good discussion about that.
    As I’m now in 2 shoes and I think Im mostly walking without pain (Week 8)
    I’m getting nervous about the healing long thing as it seemed like its difficult to tell when you have it.
    In other words, I couldn’t really find factors that affect this except dorsiflexion (I started doing a little of it at week 5 or so).
    How can you identify if you are having this problem without having to wait a year ? What are the protective measures for it ?

    Thanks!!

  13. In an extreme case of healing long the dorsiflexion on your repaired leg would be greater than that of the unrepaired leg. In other words, when your repaired foot is pulled forward towards you it would come more towards you than the other one because it has a longer tendon. To see a discussion on possible ways to avoid it and what may cause it Read:

    Skelonas

    Calf Stretching and Achilles Lengthening - Let’s Settle This!

  14. Hi Donna can we check this (healing long) by comparing the rest position of injured foot to uninjured one by hanging our feet on the air while in bed?

  15. Hi Glenskieus. That method will not work. You would need to see how much passive dorsiflexion your ankle joints have. Hanging them over a bed or in the air will not put enough force through the calf / achilles to measure the available ROM / muscle length.

    The best way I can think of to check if you have ‘healed long’ would be to passively dorsiflex both feet and measure the angles. You are aiming to have the same movement in your non-injured and injured ankles. Decreased dorsiflexion would likely impede your gait, running pattern etc. The biomechanical changes to your gait pattern from having decreased dorsiflexion can cause problems at other joints further down the line.

    If you have increased dorsiflexion at the injured leg you are likely to have reduced power and ‘push-off’. I also wouldn’t advise attempting to measure your dorsiflexion range until your PT has advised that you are OK to do stretches with a reasonable amount of strength. Doing it in the very early stages of healing could increase the chance of rupture. Also it could lead to you ‘healing long’, especially if you decided to ‘check’ on a regular basis.

    My main advice would be to follow your rehab protocol. Follow when you are able to start stretches. If you are not happy with the stretches at any point for any reason speak to your PT. When you start doing stretches compare your ROM to your good side. When they are equal speak to your physiotherapist or OS and see if they want you to keep doing stretches. If they do please ask them why and make sure you get a very good answer. Ask for a second opinion on the stretches if necessary at this stage.

    I will not tell anyone what to do on here with their rehab but when my ROM is equal I will stop stretches except as part of a normal warm-up.

  16. Kristian said: “I will not tell anyone what to do on here with their rehab but when my ROM is equal I will stop stretches except as part of a normal warm-up.”

    Agreed. This was how I was advised by PT and OS and I have not healed long.

  17. Glad to see some more back and forth on the healing long issue. Back to the original post, I also have a couple bumps on my achilles at around 16 weeks, and have had them for a while, but I can’t really remember now whether they’ve been there since the beginning. Actually, looking at them now, the one at the bottom of my incision mirrors a bump on my other achilles, so just the way it is back there I guess, though it does tend to accumulate swelling when I’ve been on my feet for a while, and also works out width wise. The other one is at the top of my incision. My pt has indicated they are both scar tissue and does massage to help break it down including light gua sha. She did some ultrasound on it last week. All these tend to help, but when I’m up and about the swelling does come back. No pain or tenderness on either bump - just seems like a knot.

    Anyway, keep us posted on your bumps as well as progress in general.

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