Where is the Lump on Achilles Tendon
Watch the video and decide
1. Is the area around the tendon painfull and swollen?
2. Does it creak when you move the ankle?
If so you have Peritendinitis or Paratenonitis
3. Do you have a lump on the Achilles tendon?
4. Is the lump on the Achilles Tendon in the middle of the tendon – like mine?
If so you have non-insertional tendinitis / tendinosis.
5. Is your problem more of a swelling at the bottom of the tendon?
You have Insertional Tendinitis or Retrocalcaneal Bursitis
Achilles Peritendonitis /Peritendinitis / Paratenonitis
With Achilles Peritendonitis / Peritendinitis / Paratenonitis it is the tissues immediately surrounding the Achilles Tendon that become inflamed. Inflammation of these structures leads to swelling in the paratenon and the movement of the tendon in this fluid filled lining gives rise to the creaking or crepitus.
When this inflammation becomes chronic there is fibrosis of these tissues lying close to the tendon which is why the area feels thickened.
The tendon feels painful to squeezing and thickened to the touch but there is no lump which moves as you pinch the tendon and move the ankle. Check the video.
Non-Insertional Tendinitis / Tendinosis
With this condition there may still be thickening of the tissues surrounding the tendon but in addition there are areas of local breakdown of the internal structure of the actual tendon itself. There are different types of degeneration that can take place in the tendon but they all lead to local thickening in the body of the tendon. This can produce lumps or nodules that can be felt through the skin – see video above. Because these lumps are in the tendon then they move when you move your ankle – you can feel the lump moving between your fingers.
Insertional Tendinitis / Tendinosis
The pain is localised to around the top of the heel bone (Calcaneum) where the Achilles attaches (inserts) -which is why it is called Insertional Tendinitis.
There may be some localised swelling here due to the degeneration in the attachment of the tendon to the Calcaneum. However another more likely culprit for swelling just above the insertion of the tendon is a Bursitis.
A Bursa is sealed sac with a slight amount of fluid in it.
Think of a polythene bag which has a thin film of oil in it and has been sealed.
If you were to take the bag and place it between your two hands and rub your hands together you would have a very slippy (friction free) movement between your two hands. This is exactly the role of Bursae in the human body.
At the heel there is a bursa between the bottom of the Achilles Tendon and the skin, and another situated between the tendon and the back of the ankle (in front of the tendon).
If the bursa becomes inflamed due to excessive rubbing, the lining of the sac produces more fluid than normal and because the sac is sealed it fills up and takes up more space becoming more likely to be more irritated etc.
In addition to becoming inflamed and swollen it also becomes quite hot and red – you will be able to feel this.
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