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Small painful lump

Discussion in 'General Issues and Discussion Forum' started by lucycool, Nov 8, 2011.

  1. lucycool

    lucycool Active Member

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    Hi guys,
    pt came in to see me this morning with a painful small hard lump on posterior heel, medial to achiles insertion.

    pt is retired, walks 6-7miles in one go, once a week, plus swimming and gym work. No med history, no trauma.

    Has had problem for 2 months and went to GP a month ago where he was prescribed ibuprofen gel which was useless.

    The lump is about 25mm and feels osseous, but not 100% sure on that. Certainly feels hard.
    He feels a very sharp pain when pressure is exerted, either when I was feeling around it ( not pushing it) or if he is wearing shoes, and then it throbs for a while after pressure relieved. There is no callous/ corn or anything like that present and no pain at all when nothing is touching it. He says it feels like a thorn is stuck inside. Even asked if I would cut it out!!!

    I said I'd see what you guys thought. I thought a calc spur, but he says it appeared suddenly so I wasnt sure. Also, if it is, do I just direct him back to his GP? (Im in PP)

    Thanks for your help on this one. He's coming back in next week so I'm hoping to have an answer by then.

    Thanks in advance,

  2. Elizabeth Humble-Thomas

    Elizabeth Humble-Thomas Active Member

    Hi Lucy, not sure what it could be, maybe a synovial cyst on the ta sheath, if so tape down hard with non-stretch strapping to encourage dispersal of fluid Or, it always possible that the patient is right and there is a splinter or shard of glass encapsulated in there. It's amazing what you can find embedded in people's feet!
  3. W J Liggins

    W J Liggins Well-Known Member

    Could be a foreign body but more likely to be a calcified bursa or osteophyte. Really, an Xray as a minimum is required for diffDx.

    Let us know the outcome.

    All the best

  4. lucycool

    lucycool Active Member

    Will get the pt to get an xray asap! Will let you know. What are the chances of the nhs forwarding me a copy of the xray or in fact letting the pt take a copy with him?!


  5. lucycool

    lucycool Active Member

    Just realised I said 25mm, I should have said 2.5mm - very small!!
  6. Admin2

    Admin2 Administrator Staff Member

  7. W J Liggins

    W J Liggins Well-Known Member

    I don't know the answer but if you telephone the Radiology Dept. you should get an answer. It's probably best to speak to a Radiologist because they will have more sympathy with the clinician and the clout to make things happen. The simplest way is probably to ask the GP. Most radiographs are digital now (ask about PACS) and you should be able to get hold of a disc with all the details.

    Hope this is helpful

  8. andersonkchan

    andersonkchan Active Member

    How old's the pt? how is his neurological status?
    Just to ascertain if he could have potentially felt any trauma / foreign bodies.
  9. lucycool

    lucycool Active Member

    He was born in 1934, but very active and neurologically all totally fine. I'm sure he would have felt a trauma or a foreign body insertion.



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