Acutely painful small lump on Achilles tendon

by Jonathan Small
(Southam, Warwickshire, UK)

I am a Podiatrist in the UK who has seen a patient referred by an Orthopaedic Foot Surgeon for an acutely painful lump on his left Achilles tendon. The lump is maximum 5mm in diameter and located over the middle of the tendon approx. 3cm proximal to the calcaneal enthesis.

It has been present for 6 months, and the patient suspected a cyst. It can hurt at anytime, even in bed at night, and is not apparently linked to activity levels.

It is intense pain that temporarily prevents continued weight-bearing, but eases spontaneously after just 2 minutes.

The surgeon categorically states that there is no evidence of cyst or Achilles ruptures on ultrasound scan. He wondered if there was a biomechanical cause, hence referral to myself.

However, my assessment revealed no gross abnormalities except bilaterally externally rotated hips and mild forefoot varus causing mildly excessive pronation in the sub-talar joint during midstance phase of gait.

Unlike the surgeon, I found a test that did illicit the symptoms in full - namely static repeat heel raises with knee straight as I was testing gastroc power.

The only time I have seen symptoms like it is in acute injury situations, but those symptoms don't subside spontaneously after just a couple of minutes!

The lump is tender when palpated, but not as painful as the test induced. It does not move or float.

Apparently 15+ years ago, the patient did damage an Achilles tendon playing sport, but does not know which one. The left tendon does appear thickened compared to the right.

This appears to be an unusual case. My online research suggests tendonosis, but the surgeon thinks tendonitis. I'd be grateful for your thoughts.



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Joshua Answers:


Hi Jonathon. It'd be happy to add whatever I may to the investigation.

Working on the assumptions that there is no cyst, no tumor, no significant rip/tear, nothing else medical that would have shown up on ultrasound, here's my thoughts.

1. So 5mm is about the size of a pea. Which to me means that there was a specific site of tiny rip/tear, and over time the body has laid down scar tissue. Microscopic tears to that new scar tissue structure and the body lays down more scar tissue. Over and over until there's a nodule of scar tissue.

The nervous system reads this as an ongoing injury, and treats it as such.


2. Static strain results in pain that goes away quickly. But also hurts other times, like in bed at night.

Acute injury pain doesn't go away that fast, as you say. But, for instance, bad shin splints can -force- a runner to stop running due to the pain, and then not hurt a couple minutes later.

It's quite possible that the same dynamic is in place here. There's definitely pain enhancing chemical from the inflammation process in place, but as the nervous system also plays a role, if it thinks there is danger, it can create pain to make you stop doing the dangerous activity.

I would think the pain from static strain that goes away quickly is more a function of the nervous system trying to avoid injury to a structure it is concerned about.

And of course, everybody and their pain is a little different, what you've described doesn't surprise or concern me.

And the pain at night is (probably) basically from the near constant release of pain enhancing chemical due to chronic, tiny injury as every day, every step has the potential to rip one of those microscopic scar tissue fibers and set the whole thing in motion again.


3. There could be some Tendonosis involved, there usually is with Achilles Tendonitis, but it sounds more consistent with the above.


4. For specific spots like this, specific massage on the tendon. I would have the client:

A. Ice massage the tendon itself frequently throughout the day, and/or

B. Just massage with finger tip. Across the fibers, circles, compressions, however one wants to do it.

Essentially, that nodule is a dry, fragile, crunchy sponge. Rub it enough and it will reshape into a soft, mobile, gummy sponge.

When it's fragile it gets frequent microscopic reinjury. When it's gummy and mobile, it structurally isn't as prone to that frequent reinjury.

There are other factors at play, of course, but one HAS to restucture that nodule. It likely won't go away, but it doesn't need to vanish, it just needs to be more squishy/gummy and less dry/crunchy/fragile.

I know that's highly technical lingo there....:)


(p.s. you submitted this on the public forum so I'll assume it's fine to post for all to see/learn from.)


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Please reply using the comment link below. Do not submit a new submission to answer/reply, it's too hard for me to find where it's supposed to go.
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Joshua Tucker, B.A., C.M.T.
The Tendonitis Expert
www.TendonitisExpert.com
















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Feb 21, 2010
PART 2 - Thank you for your thoughts - Acutely painful small lump on Achilles tendon
by: Jonathan

That information is most useful. Thank you for that.

At my initial assessment, I issued him with a gel heel pad to reduce strain on the tendon and absorb shock on initial contact. I am due to review him next week, and was planning some deep massage on the triceps surae, but will extend that to localised work on the nodule as per your recommendations.

I'll also get him to ice the area regularly, and will see how that goes.

One other query though - would a nodule of scar tissue not have shown up on the ultrasound scan?


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Joshua Comments:

Would a nodule of scar tissue not have shown up on the ultrasound scan?

I would think it would. Did the surgeon mention it, is it in the report? Did you do the measurements, or is that from the ultrasound?






Aug 22, 2010
Lump on Achilles tendon getting bigger
by: Anonymous

I have suffered from exactly the same condition for almost 6 months. The pain is only really bad when I wear hiking boots - that's unfortunate as I'm booked to do the SW Coast Path in September. I've had Physiotherapy, ice packs, exercise, bought two new pairs of hiking boots, etc... but nothing seems to work and the lump is getting bigger. I did suffer an injury to it about 20 years ago, playing netball, but my trainer at the time said it was nothing to worry about and I didn't seek medical help. I guess I just want to know, is this something I'm just going to have to live with now? I'm 57 by the way, female, and fit and active.


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Joshua Comments:

Hi Fit and Active.

I'd really rather that you -not- live with it.

What exactly have you done for this so far, specifically? What does physio, exercise, icing, etc mean exactly?

It's amazing what happens with the RIGHT tool or the RIGHT bit of knowledge....



Sep 06, 2010
Same injury but only 5 weeks old from Ed
by: ED

By the sounds of things i have suffered a very similar injury to this, but my onset started immidiately after a training session 5 weeks ago.

Doing pre-season training for rugby involves a lot of running on hard ground, and after the session i felt as if i'd slightly pulled my lower calf.

A few days later i noticed a small lump at the base of my achilles tendon, but i tried to run it off. I found it ok when jogging but as soon as i tried to accelerate it would become too painful to continue.

A physio at the club has been massaging the lump and doing a little ultrasound which has seen it decrease in size but the season is now starting and i'm desperate to get back to full training instead of sitting on a bike. You mentioned that the lump will not disappear completely, but when is the right time to know when to get back into running without re-injury?


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Joshua Comments:

Hey Ed.

The lump is a combination of scar tissue build up and inflammation/swelling.

You -should- massage it and keep it mobile and ice it.

But, that lump really isn't the problem, though it's certainly the focus of the symptom.

Get a stick, or a rolling pin, or somebody's forearm, and work all the backside of your lower leg. Gasctocs and the Soleus (which is under the Achilles tendon, kind of).

Imagine that it's all wrapped in tight saran wrap. Your job is to manually lengthen/stretch all the saran wrap that is constricting the structures of you lower leg.

Loosen all that, and there will be less constant tension on the tendon/that lump on your tendon, so there will be less tension and microtear.

You will also be able to do more work with less wear and tear. Structures work better and have more potential when they are loose and mobile, as opposed to taut 24/7 like yours are.

Make sense?



Sep 07, 2010
Here's what I've done for the lump on my Achilles Tendon
by: Anonymous

Hi Joshua
Thanks for commenting. Here's my response.
Exercise - I stand on a step with good shoes on, and drop my heels below the level of the step. I've been told it will lengthen and strengthen the calf muscle.
Icing - my Physio told me to sit with ice pack on it at least twice a day. I did this for about 3 weeks but it didn't seem to make any difference.
Physio - magnetic ultrasound (where they massage the area with something that vibrates the tissue) + acupuncture.
Despite all this, the lump is getting bigger and sometimes my leg aches horribly, all the way up to my thigh. I'm still walking and not curtailing my activities, but I haven't worn my hiking boots for months. I'm wearing hiking shoes that don't touch the painful area.
Useful site - thanks.


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Joshua Comments:

Hey there.

I was just on vacation for a week, and I wore a pair of boots I wear once a year. Something about how they were stored, apparantely, had a fold/crease rubbing against my Achilles Tendon.

It didn't hurt the first day. The second day I couldn't even wear them, because ANY amount of pressure on my Achilles tendon while it lengthened just about made me scream.

Point being, yes, if it hurts to wear a shoe/boot that touches the spot, don't wear them.

I think it's safe to say that you don't just have a lump, you have a tendon bruise.

Tendon bruises are a special kind of pain....

So.

1. Make sure you're doing Magnesium for Tendonitis.

2. Massage the lower leg like I describe in the post right before this one.

3. Exercise as you described, good.

4. If you're going to ice, ice massage.

5. Physio as described, *shrug* sure if you feel it's helping.




Sep 13, 2010
SlipHip
by: Ronny

Jonathan said: "However, my assessment revealed no gross abnormalities except bilaterally externally rotated hips and mild forefoot varus causing mildly excessive pronation in the sub-talar joint during midstance phase of gait".

You may have solved my problem. At 14 I had a slipped capital femoral epiphysis and they had to pin my hip. 39 now.

It's like the bad leg is shorter than the other. So I walk on the outside-edge of my right foot
Seven years ago, I tried a calf exercise and got a stabbing pain in my lower right calf. Couldn't walk for weeks, exercise for months. No doctor.

Later I noticed a lump on the upper Achilles tendon. May have been there for years but not noticeable with overweight calves.

But it's now there for at least 7 years and it's never once hurt since the injury.

I finally concluded it's simply overdeveloped from the way I walk on my foot, as well as scar tissue from micro tears from being overweight, plus the major tear.

Since I don't have $900 for the clinic and tests, I'm going with that :)

I noticed my lump again tonight and searched internet for curiosity, and I came across your comment, indicating the same conclusion I reached, making me feel reassured in my conclusion.

Thanks


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Joshua Comments:

You're welcome! :)

Lumps are only a problem if they're a problem. The body forms to the stresses placed upon it. So if that spot needs to be tougher/stronger, the body will make it so.

If the lump is from continued microtrauma, that's a different story. In that case, it -may- hurt some day.

Either way, it wouldn't be a bad idea to rub that lump for a couple minutes, every single day, just to keep it mobile, loose, happy, etc.



Oct 09, 2010
lump on my achilles goes away
by: krazykev

I have this lump on my right achilles, i've been told its scare tissue, if i rub,pinch and squeeze it, it will go away and no pain for a couple of day but soon comes back, is it ok to do this every day to get rid of this? i also stetch it 3 times aday aswell as doing calf raises to strengthen them. P.S. I do running as a sport.


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Joshua Comments:

Just so I'm understanding this correctly...you have a lump on your achilles tendon.

And it goes away when you massage it? Or just the pain goes away?



Oct 10, 2010
Lump on achilles and running
by: krazykev

the lump and pain seems to go away for a couple of days but gradually come back, i am still running in between this.



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Joshua Comments:

Well, that sounds like swelling. If you have a small active spot of rip/tear, then there will be a big Process of Inflammation.

And there's a Tendonitis in place, meaning there will be an ongoing process of new scar tissue build up, which will rip and tear and trigger more inflammation and swelling and pain and scar tissue build up.

A. Ice massage that spot. A lot.
B. Stretch your Gastrocs and Soleus. Gently, a lot.




Oct 11, 2010
lump on achilles comes and goes, and running
by: krazykev

Thank you, will let you know how i get on.


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Joshua Comments:

Please do!



Jan 21, 2011
painful lump on achilles tendon
by: susansmum

I have suffered with this condition on and off for many years. Had knee surgery to remove torn cartilage 40 years ago and the knee joint is now badly affected by osteo-arthritis and affects the way I walk. I need a knee replacement but am told I'm too young at 59! I don't do sports of any kind, and always wear flat/low heeled shoes. The lump is always biggest and most painful first thing in the morning and eases within a few minutes, could the change in my gait have caused this?


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Joshua Comments:

Hello Susansmum.

59 is too young? Seems to like a pretty good time to get your body chopped on. The older you are, the slower you heal, etc. Granted, they have a 15-20 year lifespan last I heard, so you certainly don't want to be needing another major surgery at 85.

Yes, absolutely, gait change can cause Achilles Tendonitis.

And you have decades of growing compensation pattern. Which means while we're born perfect with everything working optimally, overtime, we compensate more and more and get less functionally optimal. Which basically means some muscles are working harder than others, and harder then they should be.

Throw in a gimpy knee and having to compensate around that pain and dysfunction, and it makes sense that pain and problem is showing up in other places.




Mar 20, 2011
Oh, the pain, cyst in Achilles where it meets the heel
by: Jill

I have had a "cyst" on the place where the Achilles tendon attaches to my right heel for probably 15 years now. I was an avid runner at the time, but do not recall a specific injury. The spot feels like a bebe under the skin and is VERY painful when pushed... sometimes when I accidentally hit it on my shoe while putting it on, the pain will almost take me to the ground. I also experience pain during resting times, in the way of a mild ache... usually after a day of wearing flip flops or a shoe without a back. I have no idea whether that's the reason, but there seems to be a correlation. I did see my primary doctor last year about it and he sent me to a physical therapist to do some mechanics. I have flat feet... and I seem to remember him saying that my right leg muscles were unusually weaker. He sent me to an orthotics place for some custom inserts. I wear them in my sneakers, but haven't noticed any change at all in the pain or size of the cyst. Now, I am experiencing some nerve entrapment pain on the top of my foot and have no idea whether the two issues are related. I am a 38 year old female... very active, with 2 young children. I am underweight, so excessive weight is not an issue. I have tried massaging, icing, and stretching, but nothing has made a difference. Would love to hear any new ideas on exactly what this is.

SO glad to have found this site! THANK YOU!


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Joshua Comments:

Hi Jill.

I don't have much to say about the cyst....rather out of my realm.

Still, there''s always something to say... :)

Overall, my thought is, you have too much tension/tightness/constriction going on. Possibly that 'weakness' is due to muscles being TOO TIGHT and therefor they don't have much strength/contraction left available.

Get in there and open up the back of the lower leg.

Also, if you were an avid runner, if you have two kids (assuming you went through pregnancy with both) and you're underweight, then it's safe to say you could use some nutritional bolstering. Pregnancy takes a lot out of you. "Avid Running" takes a lot out of you. Etc.

On a separate tangent, do some googling for 'cyst' and 'iodine'.

Iodine (make sure you find the right kind) is proven to be VERY effective at removing cysts. Again, I don't know much about cysts in particular, and don't run across the topic too often. Having said that, it will be worth your effort to look into iodine for cysts.




Mar 31, 2011
Painful lump on heel
by: Katefromwarwickshire

I bought some shoes which were fine at first,then i noticed they rubbed,developed a small lump above my heel on the tendon,(i think),its now extremely painful to walk,in all footwear more or less,the area is red and quite warm to the touch,i am considering going to see the doctor but he is quite useless..

Its been awhile now and its really stressing me out,as i have to wear trainers all of the time,will it go away???


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Joshua Comments:

Last year I wore a pair of boots I wear once a year for about a week (camping). Turns out I stored them in a scrunched up position all year.

So I wore them all day and night when I first got there. Didn't hurt at the time.

The next morning, and for the entire rest of the week, I couldn't wear ANYTHING that even touched the back of my heel/Achilles. It was fine unless I had a shoe on and took a step.

Essentially, I, and seemingly you, bruised the tendon. Tendon bruises HURT (generally just when touched or stressed, fine at rest.

The pain and redness is due to the inflammation process.

Ice. Lots of it. Often. And be patient. It's not fast. It's not a bad thing, it's just that tendon tissue is stubborn, and you have to work at it.



Apr 29, 2011
achilles tendon cyst
by: Anonymous

I had knee replacement two years ago. During the physical therapy that followed, I developed tendonitis in the Achilles tendon of that same leg. It was so painful I couldn't put any weight on the foot-- hurt worse than the knee. Soon after I noticed a lump about three inches above my ankle on the back of my leg. The doctors said it was a cyst and not to worry. However, the sharp, stabbing, burning pain that radiates down into my ankle from this lump has become a real problem.
Some of the interventions that I have tried are: ice, stretching, massage and NSAIDs. Any relief I have found has been weak and fleeting. Thanks to this site I will speak firmly with my doctor at my next check-up about not ignoring this problem any longer.
And a comment for the lady with the bad knee, I had an Otis knee done at age 54. Best move I ever made!


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Joshua Comments:

Well -if- it's for sure a cyst, and -if- it's causing your symptoms, then yeah, no reason to not to cut that puppy out.



Jun 10, 2011
thanks
by: april

your advice was so straight forward!! thanks so much buddy!! usually a person cant understand yu know? totally appreciate it


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Joshua Comments:

I try to keep it simple and in the realm of common sense.

Less talk, more action!




Jul 07, 2011
Extreme achillies pain, and have already had Planter Fasciitis surgery on both feet
by: Jennifer

I have a knot on my achillies that is extremely sore to the touch. I have had plantar Fasciitis surgery on both feet. I had a vertical tear in my right achilles so my podiatrist castes it for 3 weeks and it was fine. Well now I have almost the same kind of painful knot on my left foot with the exception of the knot being at the top where is connects to my calf.

I guess I'm wondering if you think it could be a vertical tear? And is casting a regular treatment? Thanks


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Joshua Comments:

Hello Jennifer.

Is casting a regular treatment? Yes. Is it particularly effective? Not so much. Not in the long run, anyway, as you're experiencing.

I have no way of knowing if there's a tear or not, unfortunately.

It works kind of like this:

1. Muscles get tighter and tighter.

2. Pain Causing Dynamic grows.

3. Plantar Fasciitis Symptoms

4. Plantar Fasciitis Surgery

5. Over time, more pain, more problem. Compensation pattern continues to develop and sooner or later you develop other pain and problem.

6. Tears happen when the body can no longer handle normal daily stresses of movement etc.

Want to decrease pain symptoms and make your tissue happy and healthy again? Then I suggest either 'The Plantar Fasciitis Treatment That Works' or Reversing Achilles Tendonitis ebook. (But not both!)

You can absolutely lower your pain levels with either of those.

Want a FULL recovery from it all, surgeries and everythin? Then find out about The ARPwave System.


More questions, more answers.




Jul 27, 2011
Two bumps Above Ankle Causing Pain
by: Sue

I've been getting for sometime 2 bumps a couple of inches above my ankle bone when I jog. Now they seem to be showing up when I walk (at a decent pace).

While I'm walking or running it feels fine but when I stop it feels like something is tearing.

The pain subsides relatively quickly and the bumps recede but no longer seem to completely disappear. It seems similar to what you were discussing above relating to the achilles tendon but different location. In researching I've come across fascial hernia, chronic compartment syndrome but can't seem to pinpoint anything.

Any thought are appreciated. Hard to show a doctor unless I run first! Did find this picture on line and my bumps are very similar just closer to my ankle and more on the outside of my leg.

http://dl.dropbox.com/u/523401/photo.jpg

thanks
sue


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Joshua Comments:

Hi Sue.

Could be some in and out herniation (unlikely), and minor compartment syndrome could be at play, but it sounds like you're experiencing chronic irritation and inflammation, thus the swelling and going away.

Inflammation includes the release of pain causing chemical which makes everything hurt BAD. Your system is currently doing a great job of cycling that through (reducing the pain and swelling).

Overall, your muscles are so tight they're not absorbing force properly, and all that force has to go somewhere, which is causing problems.

Your basic options are my Reversing Achilles Tendonitis ebook

or to pull out the bigger gun, The ARPwave System.

More questions, more answers.



Aug 03, 2011
Similar Injury to Acutely painful small lump on Achilles tendon
by: Lexi

I never have had any severe injuries before. I had a problem with my ankle during track season due to unsupportive shoes, but the problems went away when I got new shoes.

I have a small lump on my Achilles tendon on my left foot, and it only hurts slightly - usually when touched and sometimes while walking/etc. It reoccurs at random times. Have any ideas as to what this is and how to treat it?

[Take to notice I have had no previous injuries]


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Joshua Comments:

Hi Lexi.

Well, the pain went away, but the problem didn't go away.

You ran ran ran, muscles slowly got tighter and tighter, new shoes irritated the dynamic, you changed shoes and the pain settled down but the structures were still tight etc.

Now your muscles aren't firing optimally and force is transferring to places it's not supposed to go, specifically that lump on your Achilles.

What have you done for it so far, self care wise, to help address the problem?



Sep 10, 2011
big achilles tendon lump
by: Cassie

Hello. I was wondering if anyone had any advice....I hurt my achilles tendon on july 30th. I have just started running again and did the elliptical for six weeks since it did not irritate the tendon. Now I have a large lump in my achilles tendon area but it is not painful to run at all. Should I still run? Should I be very worried about this or is this a common sign of healing for the tendon?


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Joshua Comments:

Hi Cassie.

Is it common? Yes.

Does it have some relationship to healing? Yes.

Does that mean it's been healing as good as new? No.

Is it a problem? Not necessarily.

Can you make it better with icing and massage? Absolutely!

Can you make the lump go away? Probably not.

Can you be totally 'healthy' and active with the lump? Absolutely! IF you ice and massage to make the ecology of the lower leg good and healthy again.




Nov 10, 2011
Lump on Achillies Tendon
by: Anonymous

Thanks for your posts.
I ruptured my achillies and bust my calf muscle playing football about 14 years ago (29). This year i aggravated my achillies playing football with the kids and since then have had a lump appear along with extremely tender achillies.

will give the massage technique a go each day and see if it can make it more malleable as you advised.

Nice to see some sense being written on this subject on the internet!

Cheers

John



Joshua Comments:

Hey John.

Is it the same side as the side you ruptured?

Let us know how it goes.






Nov 20, 2011
achilles tendon lump after hurting the achilles stopping a door
by: Lisa

Hi about 5 months ago I hurt my achilles when I stood up but the back of my foot was under a heavy metal door and my achilles took the full force of me getting up, it was extemly painful and I fell to the floor , I could hardly walk on it to start with but I rested it iced it and took ibuprofen it improved a bit over time but is still painful and tight after rest or if I walk alot and I also have a hard painful lump on my tendon,is this normal for it to take this long to heal , and also what do you think I have done. thank you. Lisa


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Joshua Comments:

Hi Lisa.

I have no way of telling what you've done from here.

I also don't know what the time period you're talking about is.

More details, more details...





Nov 21, 2011
Lisa Replies -- achilles tendon lump after hurting the achilles stopping a door
by: Lisa

it was about 5 months ago that I hurt it, while the first extreme pain has died down I been left with a constant pain ,worse if I stand on tip toes and after rest,and a hard painful lump .

but After 5 months I'm really hoping it will get better soon. stretching it does help a little, but its just not going away. Lisa


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Joshua Comments:

So, your rested it, and you iced it.

What exactly did icing it look like? Meaning, what did you do, exactly?



Nov 21, 2011
re: achilles tendon lump after hurting the achilles stopping a door
by: lisa

frozen peas, and then I bought a jel thing that you keep in the fridge until you use it by wrapping it around your ankle.


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Joshua Comments:

I suggest Ice Dipping and Ice Massaging.

Ice Packs just aren't going to do it.

Learn How To Reduce Inflammation



Dec 02, 2011
Achilles nodule after ignoring it until I couldn't walk
by: Scott

I hurt my achilles tendon 3 years ago and completely ignored it for about six months. I play sports and do a lot of calf work in the gym.

After ignoring it for so long I could not walk, it wouldn't loosen up. For the last 2.5 years I have been in and out of a air cast boot. I have actually gone through 5 of these boots. I have a nodule on my achilles that is swelling and scar tissue. It has gotten a lot better in the last 2.5 years but it still has not healed 100%.

I was schedules to have surgery on it (debriement) but at the last minute decided not to because the recovery is a year from the surgery. The most aggressive thing I do is go to work and stand and walk a bit with a heel lift in my shoe. At the end of the day I put my air cast boot back on to rest it and let it heal.

I have gone to so many specialists and they all say it should heal. I have had platlet rich plasma injections (where they inject your blood in the achilles to help promote healing), and radial shock wave therapy. Nothing seems to work except for resting it.

I have heard that chronic achilles tendiopathy usually takes about 3 years to heal if you really baby it. I am thinking it will never heal. Is there anybody out there that has completely healed from this thing? I have had 2 knee sugeries and both shoulders reconstructed so I am statring to think I should have had surgery on my achilles.



Continued In Next Post



Dec 06, 2011
Joshua Responds -- Achilles nodule after ignoring it until I couldn't walk
by: The Tendonitis Expert

Joshua Comments:

Hey Scott.

I know huh, a year to recover just from the surgery....not particularly compelling.

This will be useful for you: Why does rest help but PRP and shockwave therapy don't help?

Because A. PRP and shockwave therapy target the symptom, not the cause and B. Rest stops new irritation to an irritable dynamic.

But 'rest' is not 'relaxation'. See: Rest and Relaxation

So you have scar tissue build up. Ok. Is that a problem? Not really, and, it's a symptom. So while it's important (sometimes) to deal with scar tissue build up, the REAL problem is what's causing the biomechanical dysfunction in the first place.

And it changes the conversation a little bit if you have some actual tear in the tendon or no.

A year's worth of recovery from debridement surgery seems like wasted time and effort if the spot on the tendon isn't the CAUSE of the problem.

And all those specialists say it should heal...but it's not...why? Because they're not looking at the bigger picture. That spot on the tendon is there for a reason. And the reason is not 'there's a spot on the tendon that should heal'.

So. Moving on.

You're partly right. It's never going to heal...unless you help it heal.

I see two options.

Option #1 is my Reversing Achilles Tendonitis ebook.

For $20 and the support I provide with that, it's the best cheap option out there. It will take some time and diligence on your part. But I don't see any reason you can't get AT LEAST 50% better and more likely at least 80%.


Though considering you have knee and shoulder issue also, and depending on your motivation level, I HIGHLY urge you to consider The ARPwave System.

It can heal ruptured Achilles Tendons and total ACL tears without surgery, 6-8 week full recovery...it can correct what you have going on.

You have an electrical disruption (compensation pattern, call it whatever you want) keeping muscles from firing properly.

Totally fixable.

My ebook will help A LOT, but the ARPwave operates at an entirely different level, and can fix issues I can't even begin to touch.

Check out the ARPwave link, then let's talk if you're interested.

Dec 08, 2011
Right achilles tendon hurts when running
by: Cassie

Hey its me again. this time I hurt my right achilles tendon I believe. I hurt it while running on thanksgiving. I rested for a few days and tried to run on December first again but it hurt after 10 minutes in of running. I haven't ran since then and I have only done the elliptical for a couple days. There is a small bruise on the back of my heal. It does not hurt to walk on it or anything but after hurting it on thanksgiving It hurt to walk up the stairs for a couple days. How long do you think this will take to heal?

Also what exercises should I do to help strengthen my tendons now that I injured both of them.


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Joshua Comments:

Hi Cassie.

I don't know how long it will take to heal. What are you doing for self-care to help speed it along?



Dec 09, 2011
Right Achilles Tendon hurts while running
by: Cassie

Hey Joshua, well I havent been exercising hardly at all. I really dont know what else to do to make it heal faster. I have been scared to try to run on it again.


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Joshua Comments:

Not running on it is an ok plan for now.

So it sounds like you're not doing any self care for it other than rest. True/false?

Remind me, what did we talk about last time? (Because I'm going to ask you why you aren't doing any of those things for your lower leg, if such is the case.)



Dec 09, 2011
Cassie responds - Right achilles tendon pain and ankle pain
by: Cassie

Hey Joshua. The last time I was just wearing a brace for my left leg nothing major really. That was a pretty serious injury. I couldn't walk well for about a week. That was when I hurt myself in July. I really want to try to run again tomorrow and see how it goes. really the pain more so feels that it is coming from a tendon of the inner ankle but it feels like it is somehow connected to the achilles.


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Joshua Comments:

1. Pain Causing Dynamic

2. Magnesium for Tendonitis

3. Get a 5 gallon bucket and learn How To Reduce Inflammation.

4. Self massage. In short, if it's tight or if it hurts, rub it. Little bits frequently throughout the day.



Dec 31, 2011
Acillies swelling,
by: Julie B

Hi,
I have pain in my Achilles area, I get severe swelling all around my ankle and foot and have a lump/ nodule just above my heel in the tendon, if this is touched or bumped it can send me into space, very painful, I can't wear boots as these touch the lump, I do wear orthotic insoles in my shoes as I have a slight inversion. The pain is Fairly constant but is worse first thing in the morning, it takes me ages to get down stairs. ( I'm 45' but in general good health and fitness).
I used to run and walk a lot but had a stress fracture in he other leg so this has slowed me down, Iam not overweight BMI 23.4 so this is not the problem, I use ice spray, anti inflammitary gel, and compression bandages, Any other advice very welcome ?
Thanks,
Julie


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Joshua Comments:

Hi Julie.

Have you had an MRI? It might be worth it just to see the integrity of the tendon.

As far as suggestions for the pain, swelling, and overall health of the Achilles, see my response to Cassie in the post just previous to this one.

Also, I suggest my Reversing Achilles Tendonitis ebook.

You have something serious going on. It's worth it to deal with it effectively.



Jan 05, 2012
Another nodule on the achilles tendon
by: Robin

Hi,

I also have a little strange bump in one achilles. Just sort of noticed there one day. It is more on the outside edge of the achilles rather than down the middle. And is almost like a thin bit of string running parallel to the ground (ie. Across the side of the tendon perpendicular to it) Not really causing much pain at all. When the foot is just resting or I am standing you can barely feel it. However if I stand on those toes it is quite obvious to touch. Been doing stretching on my lower legs now and a bit of massage so hope that helps. Rubbing it or whatever doesn't cause much discomfort at all - and when I run I don't really notice it. Should I give it a bit of direct massage to the lump every day as you note above ?

I assume this sounds like not really a big deal and I should continue loosening up my lower legs and continue the exercise ? Started yoga too which is definitely loosening me up. Hopefully that helps the lower legs - as they have always got pretty tight for me after running.

Thanks in advance.


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Joshua Comments:

Hi Robin.

Yes, ultimately you have to lengthen and relax muscle and soften tendon tissue (more like gummy bear and less like dry crunchy sponge).

Keep at it, keep us updated.



Jan 09, 2012
Thanks
by: Anonymous

Thank you - I will keep on at it as its not causing pain and continue with the loosening up.

Jan 11, 2012
Lump on Left Achilles, runner, pain started 4 weeks ago
by: Muskrat

I have had a lump on my Left Achilles (approximately 6 inches above the heel) for about 4 weeks now. I am an avid runner and had been training for a marathon. The pain from this started about 4 weeks ago. I continued running, as usually it would "loosen" up after a few minutes of activity, but then it would always hurt quite a bit that night. I would ice - and the pain would be "ok" the next day, but never totally gone. I had a 1/2 marathon coming up, so I took 2 weeks off - no running at all - to let me Achilles heal. I ran the 1/2. Approximately 4-5 miles in - my Achilles started hurting. I finished the 1/2 marathon (barely) :)

My left Achilles was very sore the next day - but I had a 5 mile run to go do. Ran the 5 miles - and really should not have. (I could barely walk).

I went and bought one of those "walking boots" and immobilized it. It has been immobile for 9 days now. I can walk on it - but it is still sore. I ice it almost daily.

I had an MRI - and the doctor said there is no sign of a tear or rupture. My concern is the lump that won't go away.

My questions are:

1) Should I walk on it / run easily on it to keep it active?
2) Should I do other training like a cycle / eliptical while letting it heal?
3) Should I stretch it or try to immobilize it.

I am planning on not doing any running for 4-6 weeks - then easing back into my maraton training.

I am just really concerned about the lump.

Thanks.






Jan 11, 2012
Joshua Responds - Muskrat - lump on achilles from running
by: The Tendonitis Expert

Joshua Comments:

Hi Muskrat.

To questions #1 and #2 I say yes. (Walking certainly).

To #3 I say NO, you should never immobilize in this situation. Toss that walking boot, or put it in the closet for a rainy day.


Concern is good. Keep that. But let's redirect it.

Healing isn't the problem. Function is the problem.

The lump isn't a problem. It's a symptom and a clue.

The body shapes itself to the forces placed upon it. The lump is forming because there's undue stress on that spot. Which includes tiny rips/tears and scar tissue build up.

You've iced and gotten a certain amount of results/benefit. Great. In general, I'm going to assert your're not doing enough self care, and more importantly, not doing enough of the RIGHT self care.

From an ARPwave perspective, muscles are shock absorbers. When they aren't doing their job correctly, they're not absorbing force (every step down the road) and all that force has to go SOMEWHERE.

Muscles absorb force. Tendons don't. Achilles tendons tear and rupture because muscles aren't absorbing force, it's all going to the spot that tears, and eventually it gives way from too much stress/tension/force.

You're in the baby stages of that. (Not saying you're going to rupture, just saying that lack of optimal muscle function is the mechanism in place every step down the road.)

From the perspective of my Reversing Achilles Tendonitis ebook, structures are too tight and inflammation is causing issues. That is totally reversible.

6 weeks off isn't going to help nor fix anything, I promise. 6 weeks off with appropriate self care very likely will. Non-adequate self care and rest won't fix anything....

My ebook is the cheap (but effective) way, getting an ARPwave unit in your home is the less cheap way. It's the big gun, and it's....amazing. (Says the 53 year old lady that trained with it to run 93 marathons in 93 days.)

So it depends on your motivation level. At this point, it's going to take something to correct what you have going on. If you want to get out of pain and start getting back on the road, start with the ebook and keep me updated. If you are serious about it and it's super important to you to put in as many miles as you can, see: The ARPwave System).

Jan 13, 2012
Lump on left achilles tendon
by: Anonymous

Hello! I have been avidly reading all the posts and your responses on here; perhaps you can help me?

I have had a very painful lump on my left achilles for four weeks now which I suspect may have been brought on by going back to ballet class again after a 10 year break (I'm now 30).

Around the same time, however, I also had an issue with a new pair of walking boots which were ankle height and rubbing slightly - I got a pain so bad in my left achilles that I had to take them off (but had no problem with my right foot) and I have sadly never been able to wear them since. The lump in left achilles is now painful in some of my other footwear which had previously been very comfortable.

The pain is worst in the morning - it's like my left ankle has completely seized up and I have to hobble. I have iced the area on and off and I do massage it daily between my fingers, but I want to go back to ballet and aerobics and get fit, but I'm worried I won't be able to handle the jumps etc and may injure myself further.

Could you please give me your prognosis and advise a course of treatment to get me active again?

Thank you!

Lucy


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Joshua Comments:

Hi Lucy.

No prognosis yet.

1. Was it fine before you wore the boots?

2. Did you have a lump before the boots (and the boots aggravated what was already there)?

3. Are the boots shaped in such a way that there was a curve or ridge that was pressing into your Achilles?

4. If so, does it press in where the lump is, or elsewhere?

5. Did the pain come on fast or slow?

6. Any other details along these lines.




Jan 24, 2012
Desperate for advice, hypermobile with painful lump on Achilles tendon
by: Elaine

I have been reading all the posted comments and still fell compelled to ask about myself.
I wore a pair of wellies that folded in at the back of the heel when I walked. My strides were large and quick trying to keep up with my son.This caused a lump to form on my Achilles. This was 8 weeks ago.
I have hyper-mobility and am overly flexible in my back, hips, knees and ankles. I saw a physio who told me to do some calf stretches she also advised me to see a podiatrist. The podiatrist said it was my hips flexing forward, knees bending to the middle and my ankles rolling into the center the was causing all the pain. She has strapped my leg so that the strapping does the work of my Achilles and has given me angled pads to prevent me from walking on the inside of my feet. Also i have been given a range of core exercise to strengthen my back, hips and stomach muscles. This however has stopped me from doing my calf stretches and I am not sure if this is helping.I do the massage and ice as suggested by both my physio, podiatrist and yourself.
To top it all I am on trial at my new place of work and do not want to take time off. I am on my feet constantly for 8 to 9 hours at a time and regularly have to run the 3 flights of stairs carrying heavy equipment. I am 2 stone overweight which I know is bad for my hyper-mobility and am trying to find a way to burn fat and not damage my ankle. I cycle and use a cross-trainer but am I doing the right thing.

I do not want to lose my job and am desperate to know that I am doing the right thing. I am 44 and willing to do what it takes to get this sorted.


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Joshua Comments:

Hi Elaine.

I hear that your motivated. Ok, great.

1. For a variety of reasons including pain and weight gain/holding, get your VitaminD level checked and then get it to between 50-80 ng/ml.

2. Go off ALL gluten for the next two months. Among other ills, it is an inflammatory agent (causing pain, and weight gain, and nutritional deficiency).

3. Don't stretch. Massage. That's a specific stretch. You probably don't need to stretch anyway, as hypermobile folks generally don't have 'tight' muscles, but there is other stuff going on.

The muscle needs new blood full of nutrition.

4. See: Magnesium for Tendonitis. Get on it. As much as you can get into and onto you. Take care of 'tolerance level'.


Question: Was the shoe rubbing on the achilles tendon? Did it irritate it due to pressue and friction? Or is it that you were in new shoes and the change in normalacy caused things to go haywire?



Jan 26, 2012
I'm cured!
by: Anonymous

Hi Joshua
I've been meaning to post this thank you note for ages - sorry, life gets busy. I've just read Jonathan's post above and it sounds like his client had exactly what I had - still undiagnosed.

On Joshua's recommendations I religiously iced twice a day and massaged as often as I could throughout the day. I also did exercises on the step - lowering the heel below the step being careful to put all my weight on the other foot to return the injured foot to the starting position. Joshua said the lump needed to become soft and pliable instead of hard and crackly.

Eventually I did persevere with this regime (it wasn't easy)and the problem disappeared after about 6 months of this treatment. As this had become a chronic problem that had been going on for some 12 months before I found this website, I'm certain it was the icing, the massage and exercises that cured it.

I think my problem was caused by an old injury being aggravated by a crease in my very soft leather walking boots.


Thanks again Joshua for your valuable website.




Jan 27, 2012
Thank you for your advice
by: Elaine

Thank you for your reply, Joshua, I will follow your advice. I have a gluten intolerance so avoid this any way. Will check the Vit D and magnesium.

The weight gain was due to a fall in 2008 when I damaged my both arms, neck and back. Unable to exercise for nearly 2 years. I am cycling when the weather permits and my new job is very active so I feel this will help.

With regard to my boots they were wellington boots that were too big for me, size 5, but due to a high arch I could not get my foot into the size 3's, my normal size.

As I was walking to keep up with my son, we were late for football practice, I had to take long fast strides almost running the boot folded at the back and dug into my leg a few inches below my calf.

The next day I noticed the lump. It could have been there before but I had no pain until I wore the boots. I had been increasing my activity levels in order to lose weight, going to zumba and other dance exercise classes but had no pain prior to wearing the boots.


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Joshua Comments:

Hi Elaine.

Yeah, even in my own experience, it's suprising how fast we can cause lasting pain by having a boot rub into the back of our Achilles.

No fun.



Mar 01, 2012
lump on achllies tendon that is painful
by: jane

This page has given me some idea what the lump on the back of my achilles tendon is.

I had a melt door cut into my right achilles tendon 8 weeks ago now they said my tendon was cut 20% on the MIR but when I went back after they had clean out the wound and stiches it up (they did not stiches the tendon) they said the tendon was only scuffed ??

all I know is there is now a big lump on the back of my Achilles Tendon that stops me from walking sometimes and is painful all the time.

I ice it rub it but it is not getting any better I still can't walk right and the lump is hard and painful and sends sharp pain into my foot?

what would you do about this?


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Joshua Comments:

Hi Jane.

Well, was it scuffed, and then it ripped more as you walked around? Or was it scuffed more than they thought?

Either way, if you have a 20% tear now, that's significant.

The lump is just scar tissue forming...which would be great if it was as strong as before, but that scar tissue doesn't necessarily mean that it's strong enough to prevent any more ripping.

Plus I have no idea of your nutritional status/the structural integrity of your tendons in general.

If you really do have a 20%, I'd do one of two things.

I'd push for surgery. Doctors will first want you to get into a boot, be immobilized for weeks/months, etc. But IMHO, that's a waste of time and draws things out. Get the surgery sooner rather than later.

Personally though, I'd skip the surgery and go for the The ARPwave System.

There is some cost to it, but you won't be recovering from surgery for 6 months, nor will you have to get surgery. Alternately, you won't be in a boot for 6-12 weeks hoping not to have surgery, and then having pain, and down the line more tear and requiring surgery anyway.

That's what I'd do.

It's POSSIBLE that you'll be fine if you do all the right self care, like you'll find in my Reversing Achilles Tendonitis ebook. I'd do that before I'd do anything.

Having said that, it depends on the status of your tendon. You're either in imminent danger of more tear (if you're already at 20%, if it goes, from there it can go fast if it fails), or you're not.

You're going to have to make some choices re: that.

I'll help as I can.

More questions, more answers.




Mar 03, 2012
lump on achllies tendon that is painful
by: jane

Hi
And thank you !! yes it is torn 20% I saw the results myself on the MIR they did at the hospital
they have put me in a boot with a heel raise in it but it is the lump that is bothering me the most it is right on wear I torn the Achilles and now causes other problems!! there is pain behind the lump and also swelling from the lump right round my foot there is also sharp pain that comes form the lump down the inside of my foot it is all very worrying as I just do not think any of this is right?

the lump is big and hard and when I touch it, it is painful I have been in pool to try to help it but they don't say much at the hospital.

I am due to see a foot surgeon very soon and I hope this will get sorted out.

when I first did it I asked if they would repair the tendon they say no that it would repair itself that they were just going to wash out my foot and stitch the cut back up which they did.

will the lump just go away in time like I said it is big and hard so at this moment in time I am thinking no ? but it will stop me from putting on shoes and bending my foot down and up.? don't rally understand why I have such a big lump there?


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Joshua Comments:

Hi Jane.

That lump is a growing formation of scar tissue. It's not going to go away, unless it's cut away (and then it's just going to keep doing what it's doing so it's predictable a lump will form again. You can help keep it soft and supple with self massage.

But the scar tissue growth is a symptom of something, not the problem itself.

You have a 20% tear. Your body is kicking into overdrive to try to heal that back together.

You're immobilized and with a heel raise, which is designed to keep the structure from pulling apart. (But it also makes it heal shorter and that sets you up for problems further down the line.)

If you're not a very active person, you can probably get away without surgery. But I fear it's not going to be pain/problem free anytime soon. Nor do you heal back to as good as new, so it's predictable it'll be some amount of problem further down the road.

Regardless of your lower leg before the cut, after the rip/tear your body kicked in a big time Pain Causing Dynamic. That's essentially a Tendonitis dynamic: more pain, more tightness, shorter structures, more pain, repeat slowly or quickly.

See: What Is Tendonitis

I'm curious what the surgeon says.




Mar 06, 2012
lump on back of Achilles tendon part 3
by: Anonymjaneous

Hi Joshua,
Well I just saw the surgeon he says that my Achilles is cut 20% but they don't stitched it up unless it over 50% cut. That I am to stay in cam boot for another 2 weeks and then maybe physio.

To be honest this I feel had not been handled the best and I can say that in my foot and ankle there is still a lump on the back and I would of been happier if they had stitched it up now it has to healed by itself.

my guess is that they are worry because I have been taking steroids for lupus and they don't want to touch it!! but where does that leave me??

I feel this will take such a long time now to get better if it does?


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Joshua Comments:

Well, I certainly can't comment on their intentions since I don't know what they are.

That 'we don't reconnect it unless it's over 50% severed"...I'm a bit suspicious of that, but hey, that's what second opinions are for.

And, depending on your age, overall health, and overall activity levels (or how active you desire to be), giving it time to do it's own thing in a cast/boot, might be withing acceptable limits.

Because a torn tendon doesn't just get 'stitched' up. It's a relatively major surgical procedure.

Yes, it's going to take a while to heal. The question is, how well will it heal.

The lump isn't a problem per se. It's the integrity of the tendon, that is.

And yes, you should eat a lot of protein and good fat and go entirely off ALL GLUTEN for at least a couple months.





Mar 09, 2012
achilles tendon tear with lump
by: jane Ibbitson

Hi Joshua

First thank you for all your help I went for an ultrasound today and my Achilles to now torn even more to 40% from 20% this is due to them telling me it was only scuffed ,,,anyway I have now got outside the hospital system and am see a Doctor next week hope I can sort this out once and for all??

this Dr is a surgeon so hope he is more on the ball than the last one ? thank you for your help!!

jane


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Joshua Comments:

Hi Jane.

Ouch!

Yep, that's the danger of leaving a 20% tear to it's own devices....





Mar 09, 2012
achilles tendon tear with lump
by: jane Ibbitson

Hi joshua

like I said you have been a great help!! anyone else who has a tear like joshua says if you can get it fixed don't just let them put you in cam boot you will be in it forever (it feels that way) and I think it is better to get it fixed than leave it but was in hospital system so did not have choice now I have taken this out the hospital system to get it fixed still will take a while to heal but better to do right thing first off or you will be in cam boot for long time and that not good for your other parts of your leg

thank you
joshua
will keep you up dated.




Mar 13, 2012
achilles tendon tear and lump and possible tarsal tunnel syndrome
by: jane

Hi joshua,
I have now been told not only do I have a tear in my achillies but I also have tarsel tunnle?? know is like carple tunnle but in the foot have could I have gotten this not really sure??I am going to see the doctor this week maybe then this will get sorted??

jane


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Joshua COmments:

Getting it sorted would be good...

Knowing for sure that there's a tear or not seems something simple that a doctor should be able to handle. It's not rocked science.

Tarsal Tunnel, sure you could have that. Tightness causes problems. It's that simple.




Mar 17, 2012
Sound analysis
by: Abdul Hafezi

I have a similar problem. Do you think I should stop excercising. I am trying to loose weight from around the stomach, but have refrained from jogging as it may accelerate the damage.
Any suggestion for training
Abdul hafezi


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Joshua Comments:

Hi Abdul.

There's lots of other options for cardio other than jobbing. Rowing machines rock (plus they lengthen your Achilles/lower leg nicely). The hand crank bikes are fun too. Stationary bikes should be fine. I'm not a big fan of eliptical machines.

IN general, I don't recommend Rest. But only if you're doing the necessary self care to keep things from getting worse and to help things get better.



Apr 08, 2012
Small lump on achilles tendon
by: Linda

Hi Joshua

I have a pea size nodule (Tendonitis/Ganglion?)on my left achilles tendon just above the level of the back of a shoe. It appeared after I got a couple of mosquito bites in the same area while on holidays in St Lucia in November. Could this be the cause of the nodule?

I am booked in to have a laser applied to it in a couple of weeks. Do you think this may help get rid of it. It is painful when pressed.


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Joshua Comments:

Hi Linda.

You could have gotten a little infection from the bites and the body is encapsulating it. It could be a little cyst, maybe just scar tissue...I just don't know.

But yes, it could definitely be an odd byproduct of the mosquito bite(s).

1. What do you mean by painful, exactly?

2. What did the laser guy say the laser would do? Cut it out? Calm it down? Etc.




Apr 09, 2012
???
by: Linda

Hi Joshua
Thanks for the advice.

The lump is painful 1st thing in the morning. But get ok when I walk around. If I press it it is sore also.

I don't know what the doctor at the laser clinic will do yet as I am going in 2 weeks time. He will do an ultrasound first.


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Joshua Comments:

An ultrasound? Interesting...if the nodule is that small, I wonder what he's looking for.

Keep us updated.




Apr 09, 2012
Achilles tendon replacement
by: Jane

I have had a torn Achilles tendon that then heal up with scar tissue (a big bump at the back of my tendon) since then I have been doing pool work and working on the bump but still it hurts like hell on the bump and at the site of the tear I take meds that don't allow me to heal that fast and now the doc says that if it does not heal soon I will have to have a Achilles tendon replacement I have had this Achilles problem over 12 months what is a replacement?? operation and will this work I am sick of this and just want my foot back!


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Joshua Comments:

Hi Jane.

That's a pretty nasty catch 22. You take meds that keep you from healing, but if you don't heal soon your doctor wants to do major surgery. Hmmm.

If you're not healing from a little tear, how does the surgeon expect you to heal from major-cut-into-the-tendon-pull-tendon-from-somewhere else (more cutting) kind of surgery?

I assume that by replacement the surgeon means he's going to cut tendon from somewhere else and patch it onto the Achilles. There's no way he's going to cut an entire section of achilles out and replace it. And if he does want to do that, you should run away as fast as you can.

So, will it work? For you, I VERY MUCH doubt it.

Having said that, it's not uncommon to be hurting for 12+ months even without being on any particular meds.

You got a tear in the tendon for a predictable set of reasons. Those reasons are still in place, plus now you have all the downsides of a tear (scar tissue, weakened tendon, and more of the original reasons).

1. What self care are you doing?

2. What med is keeping you from healing?

3. Overall health?

4. Age?

5. How did you get the tendon injury in the first place?



Apr 10, 2012
Achilles tendon replacement
by: Jane

hi Joshua

to answer your questions

self care i going to pool everyday and physio once every 2 week and do the exercises she tell me to do.

the meds I am on are steroids for lupus my health is 98% due to lupus and drugs i have been on

I am 52 and cut my tendon when the fly wire door hit the back of my Achilles it was 30% cut.

I don't want any other operation on it but it does still hurt after doing all that I am doing I also rub it every night on the bump.

I just want to be able to get this better! without more cuts to my tendon I scar pretty badly
so the scar tisue that another op will leave I don't want.


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Joshua Comments:

Oh, so you did cut the tendon, ok. It's not just a little wear and tear build up.

Ok, here's what I recommend.

1. Get my Reversing Achilles Tendonitis ebook. You need a specific plan, and some specific kind of self care. 'exercises' just aren't going to get you where you want to go.

A couple tips from me isn't going to get you where you want to be.


2. Are you on a gluten free diet with the Lupus? You absolutely should be, but I'll wait for your answer on that before saying more.




Apr 11, 2012
Achilles tendon replacement
by: jane

Hi joshau
no ever told me to have a gluten free diet??
the trouble with my achilles is that I have OA in both knees and the achllies is not helpping that much the OA is cause once again by lupus drugs and wear and tear.

I will not be having any operation on my Achllies if I can help it as the toll it has taken on my knees more so my left knee since it is the right achlilles that was cut to be honest right now I am a bit sick of pain. both in my knees and in my Achilles tendon.


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Joshua Comments:

Hi Jane.

Yeah, if you're healing poorly now, the idea of a big surgery is, to me, a poor idea.

There's a lot to say about the whole Lupus thing.

And I'll just say, you MUST go totally off gluten for at least a couple months and see what happens. (Good idea to supplement with adequate nutrition too.)

Gluten is an inflammatory agent. Lupus symptoms are very often the byproduct of gluten intolerance. That's complicated and there's more to the story of course, but essentially, if you have lupus and don't know anything about gluten intolerance [and how it relates to lupus] then I VERY much suggest that you look in to it.

Start with Kerri's site:

http://www.easy-immune-health.com/correlation-between-gluten-senisitvity-and-lupus.html

http://www.easy-immune-health.com/gluten-intolerance-diet-and-lupus.html




Apr 23, 2012
Achilles hurts after all this time?
by: jane Ibbitson

Hi joshua

My achllies tendon seem to be a sarger! I have been doing Everything the physio and the doctor told me to do it has been months now and still it hurts the same? I and going back to doctor next monday the lump at the back has gone down a bit which is good but there is still much pain at the back of my achilles where it was cut 20-30% I press on the bit where it was cut just above it and below and there is a lot of pain even when I am sitting still it hurts should it still hurt like this??

I am in my shoes now Thank god have been for months and still have limp to no matter how hard I try to walk without one I can not.


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Joshua Comments:

Hi Jane.

Enlargement of the tendon is to be expected, as it tries to heal and as it deals with all the other negative factors involved.




May 10, 2012
Mine was a small lump on the Achilles tendon
by: Margaret

About 5 years ago I had mu Achilles tendon lengthened (as well as triple arthrodesis). Things have been fine. I regularly stretch using the heel below the step method.

However with the start of the golf season I've been walking up and down a lot more hills recently. Half way through the round this week it became extremely painful. I've been doing a lot more stretching and strengthening exercises but still suffering pain.

I searched the web for help and found this advice.
I have a lump on my Achilles where the surgery was. It's about 1 inch in diameter but hardly raised from the surface of the leg.

After about 10 minutes of rubbing the pain has gone. AMAZING.


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Joshua Comments:

Ta da!



May 26, 2012
please help me with my tearing achilles tendon
by: rusty

hi i weigh 230 and im 5'8 and i try 2 excersise alot and jog walk speed walk well my right achilles area feels like its tearing when i walk now i have a knot or lump on it to and when i laydown its has this most unconterable throbbing painful sensation please let me know what i did did i tear it? Ive never had problems beside it comes and goes the lumps always there but the pain only when i jog.


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Joshua Comments:

Hi Rusty.

Well, the extra weight isn't helping anything, but I imagine it's long term nutritional insufficiency/deficiency that's a big player (factors into weight gain, poor eating habits [nutritionally speaking], etc.

Unfortunately I have no way of knowing from here whether you have actually started to tear something or not.

And really I don't know enough about your history etc to have much of a specific opinion.

But if you are developing a lump and pain in the achilles tendon, I'd get to work on making that whole ecology better, as opposed to continuing to let it get worse.

And thus, the Reversing Achilles Tendonitis ebook.

There is a set of basic factors at play with -everyone-, and you need to start dealing with those factors both to lower pain levels and to get your structures healthy again.





Jun 02, 2012
lump on the back of my Achilles tendon with pain
by: Jackie

hi
about 14 months ago now I had a tear in my achilles tendon and after plaster / cam boot for 12 weeks I got back in my shoes but ever since then I have had this lump on the back of my Achilles tendon I have been too physio for over 12 months and done all the things that she told me to do but the lump is hard and painful when it is rubbed it is very painful after and the pain go up my tendon and into my foot last for hours after physio.

She told me to go back and see me doctor should the the lump be this painful after all this time?


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Joshua Comments:

'Should' is a very relative term.

Ideally, no, it shouldn't still hurt.

Realistically, depending on the size of the tear, the reality of what immobilization does, and the (general) inability of the vast majority of physical therapy to do the rights things to help tears rehab, it's not surprising.

How big was the tear?



Jun 02, 2012
lump on back of achilles that still hurts
by: jackie

Hi

The tear was 30% and they said they would just put in cast then cam boot.

when I frist started phyiso she said that the lump would go down more and be softer after phyiso but it has gone hard and like I said hurts when I have had phyiso and even when I am just sitting do nothing can't rest foot where the lump is anymore and can not wear some shoes anymore they hurt too much boots are out now as they just push up on it.

what else can I do now it been 14 months nearly 15 month and this has changed my life. i know Achilles tendon are slow to heal but my friend did hers 3 years ago and now she back running and it took her 14 months to run I must say I can't run still and still limp.


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Joshua Comments:

Hi Jackie.

First off, one needs to realize that your PT doesn't have an answer to your problem (that seems pretty clear).

The answer to your 'how do I' question is a bit involved. I suggest my Reversing Achilles Tendonitis ebook.

You need to make sure your body has the right nutritional building blocks. You need to reduce the factors involved that cause the lump build up, which are the same factors that caused the tear in the first place that casting didn't deal with AT ALL.

The lump of scar tissue isn't just hard because it's hard. It's hard for a set of reasons. The reasons must be dealt with.

Conceptually, the lump isn't the problem. The factors causing the lump are the problem. The lump is a symptom.

Your friend healed etc...everybody is different, every body is different, every scenario is different. Ideally people should be out and active etc, but when people aren't then it's time to A. investigate and B. start doing the right things to rehab the situation.

Also, see: The ARPwave System. It's a more expensive but crazy effective device that gets one back on the road in 1-2 months instead of 12-24 months. It fixes the cause of the tear, btw.

More questions, more answers.







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Joshua Comments:


Jun 03, 2012
Achilles hurts after all this time?
by: jackie

Hi

I understand what you are say that the lump was caused by scar tissue from the tear of my achilles but it has been working on for months by a phsyio twice a week and then by me I was toldit was important to get the lump moving but all it has done is go hard and painful the more it is worked on.I konw there is a problem or I would not be in such pain still after all this time.
But am I now stuck with this lump and the pain it would seem so.


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Joshua Comments:

Hi Jackie.

Tell me -exactly- what's been done to the lump by the PT and by you. What, how much, how often, when.

I'm probably going to answer your response with something like "It wasn't enough, it wasn't the right thing to do, etc," but let's see what actually happened first.



Jun 04, 2012
Achilles hurts after all this time?
by: jackie

Hi

I have been going to PT for the last 11 months I have done stretching of my Achilles and had pool work also had massage on it the calf and on the lump.

I was going twice a week but now I only go once now, at home I have done the stretching she ask me to do and massage on the lump too.

I have been told that this is as good as it may gets by the Doctor but to be honest think that a cop out on his part as That would mean I walk with a limp for the rest of my life I have even change what I eat and gone on a gluten free diet.


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Joshua Comments:

Hi Jackie.

I agree, it's a total cop out.

Or at least, what the doctor is saying is "I have no idea how to help you."

So.....here's where I say "It wasn't enough, and it wasn't the right things to do.

The lump isn't the only factor at play, but your dr and PT treated it like it was.

You got some massage, and you rubbed the lump, but, as the proof is in the pudding, it wasn't enough, and/or it wasn't done 'right'.

And it absolutely was missing some things.

Right now there are factors forcing that lump to get hard/painful, and if you don't reverse those factors, which the dr. and PT did nothing to effectively reverse those factors....

Get the Reversing Achilles Tendonitis ebook.






Jun 07, 2012
So Happy!!
by: Kris

I am so happy to have found this blog! I noticed a painful lump on my left achilles tendon about a week ago and it is painful! I also noticed after I massaged it it went away....but this morning came back and was painful. I googled the problem and found this blog! What a wealth of information!! I though I had some freak tumor or something! I think I will live! :)

Kris


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Joshua Comments:

Hi Kris.

That's good news if the lump went away after massage. That points to it's probably just swelling from inflammation.

Of course, something is causing that inflammation and swelling....



Jun 07, 2012
lumps on achilles tendon, mother of 4
by: Calligirl

I am 56 and about 4 years ago I got a lump on my left achilles tendon, don't run have never been particularly sporty but I am not unfit either.

I have had 4 children and am nearly 6 feet tall if that is relevant. I am in the US. I had an ultrasound done and it didn't reveal anything.

The pain was very intense and the lump was gradual to come over a few months. The course of treatment was all physio based and was very painful to go through.

I did that for about 8 weeks and it did improve but then it got too expensive to carry on.

Over the next few months it got much better and now I just have a thickening on that tendon.

However over the past few months my other tendon has gone the same way. I am not going to the doctors as, been there done that and will have to cope on my own.

Your advise about icing and stretching is good and I intend ( if you'll pardon the pun) to follow these at least for a while. Thanks for info.


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Joshua Comments:

Hi Calligirl.

What did you do at PT that helped? Most of that you can do at home by yourself.....

Something is causing the swelling and eventually the hardening. And it's not the tendon, it's all of the lower leg and foot together.

4 kids means you're not as nutritionally sufficient as you ideally want to be. 6 foot tall isn't particularly relevant.

Icing and stretching is just fine, if you do it right, and if it's targeting whatever is the actual cause.



Jun 29, 2012
Achilles lump and chronic tender calves
by: Wanna Run

Hello

I do hope you can help. Four years ago I damaged my foot by exercising on a trampete without shoes and got plantar fasciitis in my right foot.

So I turned to an exercise bike instead. Unfortunately this caused pain in both my achilles tendons. So I rested them and recovered, this took a few months.

Then I discovered the joy of running. Which has caused the tendonitis to return. So I have stopped running (about 6 months ago) but still have problems, mainly in my left achilles tendon. I have noticed a small lump. The pain is not all the time but even when it doesn't hurt my left foot in particular doesn't "feel right".

My calves have been tender to the touch ever since I can remember (I am 45). Just the slightest touch causes a burning sensation and there are a few lumps too.

I have started to massage the achilles tendon and the lump plus the calf muscles. Do you think I am on the right track?

I would love to run again but I have to sort this out first as just standing for long periods causes the problem to flair up.


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Joshua Comments:

Hi Wanna Run.

Plantar fasciitis to achilles tendonitis to becoming a runner, I don't hear that very often. :)

So yes, you're definitely on the right track. You need to massage your lower legs and get things happy again. (Yes, I know, that's a technical term.)

I of course think you should get my Reversing Achilles Tendonitis ebook to give you some guidance on that (because, for instance, nutrition is a factor as well, and will save you time and effort).

If your calves have always been tender/sensitive, that makes a lot of sense why you've had plantar fasciitis foot issues and Achilles tendon pain, and why running, or any on your feet activity, really, causes problems.

It's because the muscles aren't working optimally, so they're no absorbing load like they're supposed to (like shock absorbers), and all that force has to go somewhere.

More questions, more answers.





Jul 01, 2012
Lumpy Heel After Plantar Fasciitis Surgery
by: Toni

I had surgery 3 1/2 weeks ago for plantar fasciitis. Maybe I am just impatient but I am miserable. I can live with the itching and even the feeling that my incision is being pulled open even though the stitches are out.

However, I now have little blisters around my incision and my heel is very lumpy feeling when I walk on it, which I didn't notice a couple of days ago.


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Joshua Comments:

Hi Toni.

You mean, when you step on your heel it feels lumpy?

Surgery definitely changed the geography of your feet. Skin, connective tissue layers, etc, are all different now. They moved, they're moving, they're adjusting, you're putting load/force/movement on the now less stable arch of the foot, the structures move, lines of tension are different, etc.

What are you doing for post-surgery self care of the foot, and the skin/incision itself?





Jul 02, 2012
Small lumps in calf muscles
by: Wanna Run

Hi
Thanks for your reply. I have noticed when I massage the calves that there are actually small lumps which are very painful. What do you think these are?

I have also started to take zinc tablets which I believe are good for tendonitis.


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Joshua Comments

Hi Wanna Run.

Are those small lumps really just tight little knots of muscle? If they're 'trigger points' then they're small parts of a muscle that are stuck in 24/7 spasm...which makes everything around it tight and painful, constantly dumps waste product and pain enhancing chemical, etc.





Jul 02, 2012
A Revelation
by: Anonymous

Hi Yes that sounds about right. This is the first time ever I have found out what they are! Have had them for over 30 years! Do you know what causes them?

Regards


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Joshua Comments:

Is this still Wanna Run?

You've had the lumps for 30 years? Or painful calves?

Confused.






Jul 08, 2012
painful knotted calves
by: Wanna Run

Oops sorry. yes. both


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Joshua Comments:

Muscles too tight, connective tissue too tight. Trigger points (constant little spasms that pump out lots of waste product and irritant).

The connective tissue bumps....I don't know. Could just be that's what your connective tissue does. I wouldn't put too much energy into what they are, so much as on getting your body to work more optimally so it won't be in so much pain etc.




Sep 05, 2012
lump on achilles tendon
by: diana

just wanted to give my two cents...

i first got a lump on my achilles tendon a few months after i gave birth to my first child six years ago.

i went to a very good podiatrist who told me that i have very short achilles tendons on both legs. my increased weight plus the many months in flat shoes that i spent while pregnant had aggravated the situation and the continuous stress on the tendon resulted in a cyst.

he made me a pair of orthotics plus he advised me to wear heels (3" not high heels) for a few hours a day till the cyst subsided... and it did!

nowadays i wear the orthotics whenever i wear flat shoes (cannot wear them with sandals however) and whenever i feel my achilles tendon getting tender and painful (pre-cyst), i wear heels for a few hours and the pain disappears!


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Joshua Comments:

That's great Diana.

Having said that (seriously, anything that reduces pain and symptoms is a good thing at least in the short term), there's no such thing as Achilles Tendons that are 'too short'.

It's more a function of muscles connected to the tendon being chronically too tight and thus constantly pulling on the tendon 24/7.




Sep 06, 2012
pain lump had for nearly 18 months
by: jackie

I just read what you told the last person that there is no such thing as too short achilles tendons ..so can you tell me why my doctor says that I will have to have an op where they take a tendon from your big toe and fix the Achilles I have been to months and months of painful physio and where she work on the whole leg not just the lump which stops me from doing thing wearing shoes I want and is still painful my physio says that she has work on my leg and the lump more so my leg and that the lump is not going down or going to go away.

I wear heel raise and the things they made and put in my shoes but there is only one pair of shoes I can wear cos the bump is to painful.


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Joshua Comments:

Hi Jackie.

Yes, good news/bad news I can tell you why.

1. Your doctors and PT's don't know how to fix your problem.

2. Your doctors and PT's don't correctly understand WHY you have the problem in the first place.


How do I know this? Because A. you're still in pain and B. you're being treated like you have a 'short' tendon, and that the short tendon is the problem, which is absurd.

You don't have a short tendon. Your muscles and connective tissue are too tight and are constantly pulling on the tendon. Thus it occurs as 'tight and short'.

Thus they give you heel lifts to 'shorten' the tendon. What's really happening there is that the distance between heel and knee is reduced, which reduces the stretch on the overstretched tendon/muscle structure.

This can reduce symptoms in the short term, but just helps things get shorter and tighter and worse.

This same misunderstanding of what's going on in there leads to 'Hey, let's chop into your body, take some tendon from elsewhere, destroy your current tendon, and 'lengthen' the tendon.'

That sounds like a good idea, right?

Uhmmmm, no.

That's like saying "You're hungry? Let's do surgery and make your stomach smaller."

Hunger is a symptom. What do you do when you're hungry? You eat, you don't get surgery. Surgery can't fix the symptom of hunger, and nobody would even dream of doing surgery for hunger. (Surgeons do, I'm sure.)

Achilles tendon pain (and lump) is a SYMPTOM. Would you rather get surgery for a symptom, or would you rather address the CAUSE of the symptom and fix that?


So. Your doctors haven't fixed the problem, they haven't even addressed the problem.

The problem is multi-faceted. For instance, nobody's said anything about nutrition to you.

I'm sorry you've spent 18 months with this....but that's the magic of hospital medicine in the realm of tendonitis and related pain.


You need to lengthen the muscle and connective tissue to take some constant irritating tension off the tendon. You need to deal with the inflammation process. You need to deal with nutritional insufficiency.

Otherwise, the pain and problem will never go away and will predictable get worse.




Sep 19, 2012
good advice
by: Anonymous

so overall,

massage
stretch
rest
ice

?


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Joshua Comments:

Nope. Not overall.

I don't suggest Rest, nor stretching as it's normally described. Light stretching is ok, as long as the focus is on 'lengthening' as opposed to 'stretching'.

Ice, if used correctly, yes. See: How To Reduce Inflammation




Nov 14, 2012
please can you tell me
by: joy

Hi can you please tell me I know this may sound silly but the lump on the back of my achilles tendon which is very painful is it part of the tendon ? or is it a lump pressing on my tendon as I can't wear shoes and it is painful all the time

Yes my achilles had an injury which is now healed up there was a 40 % tear that was 16 months ago.


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Joshua Comments:

Hi Joy.

Hopefully it's just scar tissue build up and some inflammation on the tendon.

Otherwise it's a cyst or a tumor.

It's almost certainly the former, but you'll have to feel around and see what's what.



Nov 14, 2012
lump on achilles after 40% tear
by: joy

Hi
this lump is is much bigger than a pea it more like a small pebbel it stops me from moving my foot up and down and is so painful. it just feels hard to me..which is why I ask if it was part of my achilles Tendon?

it really has and it changing my life as to what I can do I love to walk and I can do that foe too ong now as it will stop me from doing so I can wear shoes I like as the big bump will not let me.

I went to physio on it for 12 months and she said that the bump should not be there and to go back and see doctor...he just wants another MRI which will be 3rd one....that fact is that this would be ok if it did not get in the way of what I love to do walk and be active.


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Joshua Comments:

A 3rd MRI? What do they hope to gain from that, I wonder?

Maybe they're checking to see if it's 'grown'.

So if doctors etc have seen it I imagine it's just scar tissue build up as opposed to something medical.

They'll likely end up wanting to do surgery to remove it...which might be ok, but nobody's dealing with why it's forming in the first place.

But yes, pain is a problem. If it was a lump with no pain, then it wouldn't be much of a big deal.

You say you had a 40% tear. Did you have surgery, or did they just put you in a splint/cast?




Nov 15, 2012
Lump on Achilles tendon
by: joy

Hi
yes the put me in a cast for 8 weeks and then a cam boot for another 4 weeks no they did not anything else but that then Physio for 12 months.

I really have no idea why they want another MIR no the lump has not grown it has also stayed the same the doctors thought it would go down or go away a bit with physio but it has not and it get more and more painful.
you are right it would not borther me if there was not so much pain there I would not even go to see the doctor I would leave it but as I say it just gets in the way of what I want to do I have always walked a lot and do lots of out door stuff now I can not do that any more .
and you ask a very good question why is the lump there at all why did it get so big and painful? they have never answered that question?

Nov 16, 2012
Lump on Achilles tendon after 40% tear
by: joy

Hi
1. yes they just put it in cast and boot for 12 weeks
I have no idea why they want another MIR as the Lump has not grown but it has gotten no smaller it is the same as when they took it out of the cast.It has how ever gotten more and more painful as time has gone on and I have use my foot as I said before I like to walk and be out doors this stops me from doing that.

no one has said why I got such a big lump there it as if they do not want to say.I have asked but was given some really lame reply.

I am now at the end with it as it is so painful it hurts all the time and shoes are so painful to wear.they have not said what they will do once they have the MIR but I have to then wait a week and go back to find out.


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Joshua Comments:

Your Achilles tore.

The docs just shortened the structure (hoping the torn parts would press together and heal back together) and held it there in the cast.

So assumable the tendon knitted itself back together. But it's never back to 100%. Plus, you were in a shortened position for months. Thus, muscle got used to the short position and that became the new normal, and connective tissue shrunk wrapped.

So now you stand/walk, and theres too much tension on the weak part of the tendon. So microscopic scar tissue bits tear off, and more scar tissue lays down to 'heal' that. Thus a lump forms.

The other problem, is that the CAUSE of the original tear was never addressed. So all the same forces and factors that caused the tear in the first place are still in action, and worse than they were before.

Doctors can't answer the 'why' question, for some reason. Casts and surgery and PT, that's all they have in their tool box. Which I think is pretty, as you say, 'lame'. But that's how it is.

And thus I HIGHLY suggest my Reversing Achilles Tendonitis ebook.

It tells you how and why, and what to do about it to reduce pain and help correct the source of the problem.

The ARPwave System may or may not be overkill, but if you want a fast and deeply effective fix.....

Either way, you need to reverse the factors that are causing the pain and dysfunction. No amount of Rest will fix this.



Nov 17, 2012
lump on Achilles
by: joy

Hi
Yes I know that no amount of rest will fix it but also over 12 months of PT did not either
the only two people that have been any help with this is my PT and and the guy at Podiatry at least the make some sense the Doctors don't ??

this has been going a long time now and ..Yes it will go of long the hard thing is that anyone goes near the lump I can not stand it my calf has be work on so the is does not pull on my achilles but even the pt says that the lump is something I have to think about. As she can not touch that part or go near it it is hard for her to do what is wants.

I think No matter what I do now it is a long road back and then it won't be back to A1 every again but all I am want is to walk and be without pain wear shoes I want. ok there maybe some things I can't do but I will take it as it comes.


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Joshua Comments:

Hi Joy.

So what exactly are you doing for self care? 'PT' is a bit vague (although I probably know what you've been doing, I like to be certain)...specifics please.




Mar 24, 2014
Bruised tendon or bursitis?
by: Jo

At the beginning of February, I bought new pair of work shoes, quite tight at the back. I wore them whilst walking around the city for about 3 hours one evening. The next morning, when I put the shoe on, I could feel pain on the back of my heel where it rubs against the back of the shoe.

I ignored it thinking it is just a blister. I play football competitively, do rock climbing, play tennis and swim. I tried exercising with the mild pain for 2 more weeks but noticed a small bump on the back of my heel. There is/was no other pain, my calves are quite tight, but my Achilles does not hurt at all.

The bump only hurts when it rubs against my shoe or I massage it - it is mild pain, completely bearable.

After 3 weeks of it, I decided to rest and took time off for a week. The bump got smaller but was still painful when I wore shoes other than my old battered work shoes, since the area is actually outside of the shoe in those ones.

After a week of rest, I decided to try it out and went for a run. As soon as I started running, I felt rubbing and pain but I ran 5 miles with it.

Afterwards, the bump had swollen and was painful to the touch. I iced it and went to see my GP 2 days later. I was diagnosed with Achilles tendonitis and prescribed naproxen.

It seemed strange to me as my Achilles does not hurt at all.

I went to physiotherapist the following day and he agreed with me. The bump is getting smaller with taking anti-inflammatories, icing and deep tissue massage performed by my physio (twice so far) for a week now and I have not been exercising except for swimming.

I scheduled an appointment with orthopedic surgeon for tomorrow morning for peace of mind.

Am I right with thinking that I might have bruised my tendon with wearing pinching heel which caused inflammation and possible bursitis?

Once the swelling goes down and I massage the area it feels like there is some kind of scar tissue formed on the back of my heel which feels better after massaging it, but comes back.

Any thoughts?


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Joshua Comments:

Hi Jo.

"It seemed strange to me as my Achilles does not hurt at all." It seems strange to me to, but doctors use that diagnosis all the time, anytime there's pain in the area.

-CONTINUED IN NEXT SECTION> -

Mar 26, 2014
Joshua Replies to Jo
by: The Tendonitis Expert

-CONTINUED FROM LAST SECTION-

"Am I right with thinking that I might have bruised my tendon with wearing pinching heel which caused inflammation and possible bursitis? "

Inflammation and irritation of the tendon, absolutely. Bursitis, very unlikely.

I once walked around a festival for a night with a pair of new boots. Turns out a ridge in back was totally pressing into my achilles. I didn't feel it that night, but the next day....for a week I couldn't have anything touching my achilles tendon or it would HURT. Didn't hurt at all if nothing was touching it....tendon is funny that way.

You may have had some pre-existing weakness of the tissue such that the pressure/getting rubbed on causes the body to notice a little tiny little bit of tendon fibers wearing way and is not throwing a lot of new scar tissue at it trying to 'heal' it.

Ice massage it, good massage of the muscle and connective tissue of the back of the lower back of the leg, and time. Extra protein. Natural anti-inflammatories.

Inflammation Causes Vitamin B6 Deficiency



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