How to treat a lump on your Achilles Tendon in 2021

Have you developed a lump on your Achilles tendon recently? There are only a small number of reasons for a lump on the Achilles Tendon.

Most are due to Achilles Tendonitis (now called Achilles Tendinopathy), however other causes include an Achilles tendon tear if the mechanism was sudden.

In rare cases where the pain is close to the heel, conditions like insertional Achilles Tendonitis, bursitis, Haglund’s deformity or cancer (this is extremely rare) need to be considered.

This article will delve into how and why this lump can develop, then ways to treat a painful or painless lump on the Achilles tendon.

Want to skip ahead?

What causes a lump in the middle of the Achilles?

What causes a lump at the base of the Achilles?

Can cancer cause a lump on my Achilles?

How to treat a lump on the Achilles Tendon.

What causes a lump in the middle of the Achilles Tendon?

Photo of mid-stubstance achilles tendonitis

The Achilles tendon is the largest tendon in the body, and it attaches your calf muscle to the base of your heel. It is made up of thousands of collagen fibres, twisted together like a rope. The tendon is slightly springy and can absorb and transfer load.

The cause of the lump on your Achilles tendon will differ depending on if the incident was sudden, or if it happened over time. Explosive movements, like charging into a sprint or jumping, can result in a partial tear of the Achilles.

If the lump slowly developed over time in the middle of your tendon, you can be fairly sure that the diagnoses will be Achilles Tendinopathy.

Achilles Tendon Tears

A lump can develop on the Achilles tendon due to inflammation and swelling after sudden pain from an Acute tendon tear. This swelling will not be just around one point, but more broadly across the ankle. You may also notice decreased power due to pain in the Achilles tendon.

Swelling in the Achilles tendon is due to inflammation, which is the bodies response to heal. This inflammation is activated to bring nutrients to the damaged cells so they can begin healing. This is normal and should resolve in a few days to weeks as the tendon tear settles.

Mid-substance Achilles Tendinopathy

In contrast to an acute injury, lumps on the Achilles formed due to Achilles Tendinopathy generally take longer to heal and are not healed with rest alone.

Achilles Tendonitis usually begins when the tendon is loaded beyond its capacity. Increased load starts a process where parts of the Achilles tendon begin to change shape.

The symptoms of Achilles Tendonitis are pain and decreased load tolerance, as well as a lump in the Achilles Tendon.

Lumps on the Achilles tendon due to Achilles Tendinopathy are formed by changes that happen at a microscopic level.

The Achilles Tendon fibres usually run parallel like cords in a rope. This gives the tendon great strength to resist any tension or pulling force.

Anatomy of a tendon

In Achilles Tendinopathy these tendon fibres become twisted and tangled. There is more growth of blood vessels in the affected area and there is more fluid that accumulates.

This process usually happens in one part of the tendon while the rest of the tendon remains healthy.

This will cause a lump to form on the middle of the tendon.

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What causes a lump at the base of the heel?

A lump on the Achilles tendon at the base of the heel can be due to several causes. The most likely is insertional Achilles Tendonitis which differs slightly to mid-substance Achilles tendonitis explained above.

Other causes of a lump at the base of the heel could be Haglund’s, bursitis or posterior ankle impingement. These are all explained in more detail in our Ultimate Achilles guide.

Insertional Achilles Tendonitis

Insertional and mid-substance Achilles Tendonitis are identical except for where the symptoms are located. For insertional Tendonitis the swelling is much lower on the tendon where it attaches into the heel.

Common symptoms for insertional Achilles tendonitis are heel pain in the morning, pain in the heel and swelling at the base of the heel.

Treatment is the same for both insertional and mid-substance Achilles Tendonitis and explained below.

Can the lump on Achilles get bigger?

Achilles Tendonitis is a process and if left untreated there is a chance the lump will increase in size. There is a limit to how much the lump will grow and eventually it will stop.

It is important to treat the lump as soon as possible, as the tendinopathy process will continue even if the lump has stopped growing bigger.

Can cancer cause a lump on my Achilles?

Any lump that looks suspicious should be medically examined, however it is unlikely that cancer will cause this pain. It is even more unlikely if the lump is in the middle of your Achilles Tendon.

Malignant cancer in the heel is very rare for middle aged people but can affect children and adolescents and people over the age of 60.

The signs could be a general pain in the heel, and later in the presentation swelling can also be present.

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How to treat a lump on the Achilles Tendon?

Research has shown again and again that passive treatments like rest or ice will not work for Achilles Tendonitis. What has shown to work is graduated loading of the Achilles Tendon.

The focus of rehabilitation should be finding a load that will challenge the tendon, without aggravating it – as too much load can be problematic.

The term load just means any load that we put through the tendon, this includes activities like your everyday walking, running, jumping or any treatment like exercises/stretches.

You will be able to do this by listening to your body.

Latent pain is pain that occurs after an activity, usually one hour up to a day after. If you have latent pain, it means that you have loaded the tendon too much.

General Advice

General advice would be to avoid explosive activities like sprinting or hopping.

If you are a runner, it is advisable to continue with running, but adjust the distance you run so you aren’t getting latent pain. We have given an example of a running plan in our article running with heel pain.

Begin with a program of calf raises which we have explained in detail.

Seated Calf Raises

If you need further help with finding the right amount of load, please try our Achilles Challenge which walks you through the exact rehabilitation for Achilles Tendonitis and you can access a free heel consult here.

It is advisable to wear the correct shoes as this can impact some people’s pain. And some people respond well to a heel lift in their shoes.

Passive treatments aren’t recommended on their own, but they can sometimes supplement the exercises by giving temporary pain relief. You can try taping for Achilles pain, or other soft tissue techniques like massage for the calf muscle.

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Conclusion

A lump in the middle of your Achilles tendon usually means Achilles Tendonitis which is treatable with exercise most of the time.

If the lump on your Achilles tendon is at the base of the heel there could be a few diagnoses. Most will respond well with treatment, however some may need medical management.

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How do you treat a lump on your Achilles

Exercise is the best way to treat Achilles Tendonitis. Research has moved away from passive treatments like rest or ice and towards exercise and load management.

Can tendonitis cause hard lumps

Yes it can, as the tendon is filled with new blood vessels and fluid that accumulates in one area.

What happens if Tendonitis goes untreated

The tendon will not recover on its own. It needs to be managed by loading the tendon appropriately, so that the fibres can re-align and the tendon structure can improve.

References

Jill L. Cook, Dimitrios Stasinopoulos & Jean-Michel Brismée (2018) Insertional and mid-substance Achilles tendinopathies: eccentric training is not for everyone – updated evidence of non-surgical management, Journal of Manual & Manipulative Therapy, 26:3, 119 122, DOI: 10.1080/10669817.2018.1470302

Mascard, E., Gaspar, N., Brugières, L., Glorion, C., Pannier, S., & Gomez-Brouchet, A. (2017). Malignant tumours of the foot and ankle. EFORT open reviews2(5), 261–271. https://doi.org/10.1302/2058-5241.2.160078

Tanusha B. Cardoso, Tania Pizzari, Rita Kinsella, Danielle Hope, Jill L. Cook, Current trends in tendinopathy management, Best Practice & Research Clinical Rheumatology, Volume 33, Issue 1, 2019, Pages 122-140, https://doi.org/10.1016/j.berh.2019.02.001.