Achilles rupture- recovery and now tendonitis (w/ cyst & scar tissue )

by Aaron L
(Miami, Florida, USA)

Achilles Tendon Cyst growing after achilles tendon rupture surgery

Achilles Tendon Cyst growing after achilles tendon rupture surgery

Hello. My name is Aaron, 24 y/o male, active, fit and weight training my whole life- was a competitive swimmer and water polo player and 1 year of Olympic lifting 2015 - 2016(after recovering from an Achilles rupture in 2013)


History: 2013 ruptured left Achilles tendon in a traumatic accident. I was holding up a sheet metal gateway with my barefoot and did not realize it was raw metal on the bottom and it slit my tendon in half midway between heel. Had surgery from a great surgeon who repaired it (not sure on specifics). I did PT for 3 months and recovered beautifully. With more PT at home and weight training, I got 100% use of my left Achilles tendon and recovered from muscle atrophy in calves.

After the end of 2013 till November 2016 my Achilles has been great- even now with my abnormality I still feel good.

Fast forward 2016 (around November)- In 2015 and 2016 I got into heavy lifting (mainly squats and deadlifts) would do it with more or less proper form (so I thought).

I would wearing lifting shoes (Adidas) and deep squat around 300 - 500lbs in my peak strength- Which I may attribute to this issue due to slight inflexibility of my heel. Noticed in late November 2016 I had a small bump near the bottom of my heel which is (still) about 5 - 6mm in size and raised enough that It will form a hole in my running shoes from the friction and contact- It currently doesn't hurt, but it will get sore from time to time- depending on the shoes I wear but over all no pain. I can rub it and touch it without any pain.

Currently, 3 months after noticing the cyst, it has not grown but it does swell up with different shoes. I can walk and run perfectly fine with no pain (If i am barefoot) so I have been doing slip on sandals for a while now and I want to get back to wearing any shoe I need to wear as well as my usual activity.

I read a bunch of your responses and you seem like a very educated and experienced individual- I currently am seeing a podiatrist who jumped straight to surgery- which I don't necessarily like but he is a well known Dr. with good reputation. He ordered an MRI which I did and received the results which the Dr. described to be a cystic mass (fibrous and mucitinic) similar to a cyst.

On palpation the "cyst" is hardened and I thought it was a bone growth before I got the MRI- but it is slightly movable. The Dr. says it is most likely a
cyst (with scar tissue) which seems to have formed from a small tear in my Achilles tendon (due to tendonitis) but he says the tear is very small and most likely will not need surgical repair, just excision of the cyst. I do not want to opt for surgery, even for a small tear- i know most times these things heal on their own with therapy and perseverance.



QUESTION: what can I do, what are my options? What is your opinion on the matter, and if I press and massage it daily, can it reduce it enough to go away?

Also, how can I prevent this from happening again... I am a very athletic person, I love hiking and working out and I just want to go about this in the most conservative way while nailing the cause of this.

Thanks again,

Aaron L



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Joshua Answers:

Hi Aaron.

Obviously slicing the achilles tendon isn't great.


Questions:

1. Is the cyst in the same place as the original cut? In other words, is the cyst growing in/on the spot the severed ends of the tendon healed back together?

If not, where is it in relation to the original injury site? If I'm seeing the pictures you included correctly, it looks like the cyst is an inch or so below the original slice to the tendon.

2. Presumably the cyst wasn't around before the tendon injury. Sounds like you only noticed it after.

3. Clarify: Weight lifting and running doesn't hurt the cyst, but the cyst rubbing on the shoes does?

4. Have you looked into the 'barefoot' running thing at all? I only bring that up as there may or may not be 'proper' shoes for you.

5. Is the cyst deep in the tendon/tissue or is it superficial or 'on top' of tendon tissue.


You may or may not have had it before, but you definitely have an Achilles Tendonitis dynamic now.

I'll explain it all plus cyst formation, and answer your questions, after you answer the above.



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Joshua Tucker, B.A., C.M.T.
The Tendonitis Expert
www.TendonitisExpert.com
















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Comments for Achilles rupture- recovery and now tendonitis (w/ cyst & scar tissue )

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Feb 04, 2017
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by: Aaron

Questions:

1. Is the cyst in the same place as the original cut? In other words, is the cyst growing in/on the spot the severed ends of the tendon healed back together?

If not, where is it in relation to the original injury site?

The cyst does not seem to be on the place of the original cut, although close.

In relation to where my Achilles' tendon was sliced, the cyst seems to be right below it, the cut was at a high angle so it was not a horizontal cut. You're correct, about and half and inch to an inch.


2. Presumably the cyst wasn't around before the tendon injury. Sounds like you only noticed it after.

Yes noticed it after, like I said surgery was in 2013 and I noticed the cyst in November of 2016. If it was growing it was definitely unnoticeable until this point


3. Clarify: Weight lifting and running doesn't hurt the cyst, but the cyst rubbing on the shoes does?

Yeah the cyst itself is basically pain free. I can rub it and massage it and it's pain free. The only time it gets sore is when shoes rub on it.

More so, depending on the shoe and how stiff the heel is.


4. Have you looked into the 'barefoot' running thing at all? I only bring that up as there may or may not be 'proper' shoes for you.

I am actually not much of a runner at all. I like hiking and weight lifting both require either boots or lifting shoes. I am more concerned about wearing the shoes I need to wear than alternative shoes.


5. Is the cyst deep in the tendon/tissue or is it superficial or 'on top' of tendon tissue.

The cyst is actually very superficial, seems to be growing off the tendon maybe at a point where I have a micro tear due to a sport related injury (although I have no pain or redness or even inflammation other than the cyst)
Feb 04, 2017
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starstarstarstarstar 		Joshua Replies RE; cyst on achilles tendon injury
by: The Tendonitis Expert

Ok, so even being very athletic, you/your leg feels good, except for the cyst.

So, we need to talk about two things:

1. The cyst

2. The future of your Achilles


They go hand in hand, so I'm just going to talk for a bit here.

So.

Most people with Achilles tendon rupture experience rupture because they lose muscle function, so the muscle doesn't absorb force like it's suppose to.

That force still has to go somewhere, that's where rupture happens.


Your pain started from a cutting injury, so the factors that cause that loss of muscle function are not the source of your rupture.

BUT! Post surgery you are developing those factors (you already were) at a faster rate than you (probably) already were.

Muscle Tightness
Connective Tissue Tightness
Inflammation Process
Nutritional Lack

Those factors work together to make each of the other factors worse.

You're young, you have youth and vitality on your side, but you can't escape the factors.

By default, there's a downward spiral of increasing tightness, pain, tightness, etc.

It happens fast, or slow, depending.

Ultimately it only goes back an upward spiral if you actively push it that direction.


So. Moral of the story is that those factors are at play.

You, specifically had an injury. Your skin and tendon were cut by something sharp. You had reattachment surgery, and that seems to have been done well.

GREAT!

But....you had a huge uptick of the factors. Even though you may or may not have noticed an increase of tightness.

You're young, healthy, athletic and motivated, so you're back to being athletic.

GREAT!

But....that downward spiral is in play.

Ideally, muscles absorb force. But now, they're not doing as good a job of that.

That force is going somewhere.

One could make the case that it's going to the spot where the cyst is growing.

The lines of force are different now than they were pre-injury. They don't have to be a lot different to start causing problems.

So torque is hitting the entirety of your achilles tendon (and everything it attaches to) in at least a minimally non-optimal way.

Forces are tugging where they shouldn't be, and/or more than they should be.

MAYBE there's a little tear right there that is causing the cyst to form. Maybe not. Ultimately, the force-in-the-wrong-place is triggering that tear and/or the cyst growth.

But it doesn't matter. What requires your full attention right now is the factors that are progressively getting every so slowly worse.

Cut the cyst out, or not, what you ultimately need to correct is the forces stealing your muscles' ability to function.


1. No, you can't massage the cyst away.

2. You can reverse the negative factors, and the cyst probably won't get bigger/worse (unless it keeps rubbing on shoes and getting irritated, but that growth trigger would be coming from an external force).

3. Since it's so superficial, it's probably not the worse thing in the world to have it removed.

You're young, one could make the case that you're better off getting rid of it now instead of when you're 40 or 60.

Having said that, if you just remove it, it's likely to come back.

So if you remove it, you should (first) get to work on reversing the negative factors, because you will heal better, recover better, and have a future of a life of better function (thus less pain, less injury, less weird things like cysts happening).


I of course suggest the Reversing Achilles Tendonitis program.


Make sense?

Questions?
Feb 06, 2017
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by: Aaron

Hey thanks for that reply!

That makes total sense and I was thinking the same thing in terms of the cause and the outcome.

I don't want to have surgery and now that I know it won't just go away, I want to do everything I can in terms of therapy and strengthening or whatever I need to do to prepare for surgery and my post surgery recovery. I do not want the cyst to form again and I want to prevent that from happening.

I see your program and I do believe it can help. But till I make the dive, which I most likely will, are there a couple of examples of exercises or stretches that you can give me for my post surgery recovery or even pre surgery?

(As per other comments)I agree and I just wanted to clarify some things with you:

1. My Achilles tendon, is being affected by tendonitis (so it seems) due to my surgery which has ultimately compromised my achilles tendon whether I had good Physical therapy (post-surgery) or not.

2. The cyst is a formation due to localized micro cuts or some kind of over use-syndrome that has formed in that particular area due to increased force and pressure on to the tendon. Either way, needs to be corrected and addressed as you said.

3. So if I were to go to surgery, and remove the cyst I will be prone to the cyst formation- and this makes sense because removing the cyst is only removing a symptom of a problem which is exactly what I want to get to the bottom of.

4. Before I opt for surgery (which I most likely will) I want to make sure that I am doing everything I can to correct and prevent the cyst and the tendonitis from getting worse or from forming in the future. What are some exercises you would recommend for me? Maybe just a couple of examples- that w a specific therapy would target to treat my tendonitis AND cyst.

5. Is there specific therapy I can do before surgery to enhance the outcome and post-surgery recovery? Also- ultimately the exercises you'll recommend after my surgery will be crucial- and how I tackle this issue all together; I would like to learn more about this.

All in-all I am very pleased with your responses and your expertise in this issue. If you could just answer these questions and maybe just give a few examples of the kind of therapy I could be doing, that would really help me to make a decision to commit to your "reversing Achilles tendonitis program.."

My main concern is that my issue seems to be very specific, especially due to the cyst- and I just want to make sure your program will be able to really target my specific needs- rather than just a generalized program for tendonitis, I hope you understand.

As always, I look forward to hearing from you

Aaron L


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Joshua Comments:

1. Sort of accurate.

Your entire lower leg had decreased function due to the tendonitis -dynamic-, which is made up of multiple factors all working together to cause pain/problem/decreased function.

Due to the injury and resulting repair surgery, those factors increased quickly.

2. Essentially, yes.

3. Exactly.

4 and 5. I'm not trying to be coy or evasive, but as a general rule I don't suggest 'tips or tricks'.

Tendonitis (and equivalent decrease in optimal function) is a dynamic, with multiple factors. One needs to effectively deal with all of them.

If I told you 'Eccentric Heel Drops, because they help reset the length of too tight muscles, and you did them, you would get some benefit but not a 'fix'. (They're not in the program, btw).

If I told you 'self massage, get in there and open up too tight structures', and you did that (which would be great), if you don't do it enough, or do it 'enough' without covering the other bases then you won't get as much out of it as you would if you dealt with all the factors. (There is a specific self massage in the program that I think gets you the most bang for your buck compared to other ways of massaging.)

Thus, the whole program is my recommendation.



"My main concern is that my issue seems to be very specific, especially due to the cyst- and I just want to make sure your program will be able to really target my specific needs- rather than just a generalized program for tendonitis, I hope you understand. "

I do understand, and I appreciate your concerns.

A. Your symptoms are specific, but your 'issue' is not. Your issue is a decreased lack of your lower leg's ability to function correctly/optimally.

In your scenario, that is resulting in the signals telling a cyst to form.

Ironically, your specific needs are covered in the 'generalized' program for tendonitis...because 'generalized' tendonitis is a dynamic very specifically made up of three primary negative factors working together to cause pain/problem/decrease in function.

(Also in case it needs be said, the program would be done before and after cyst removal surgery.)

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