Large knot on achilles tendon, painful lumps on top and side of foot

by Erin
(Dallas, PA)

Dear Dr. Mitnick,

I will apologize for the length of my post in advance.

I am a 35 yr old female, 5'6 tall and weigh 145 pounds. I was dxed with Crohn's Disease at 22 yrs of age and Primary Sclerosing Cholangitis at age 26. I'm currently on a host of medications among them Prednisone- and have been steroid dependent since my dx of CD. I'm prone to unusual manifestations as I've been told by several doctors. A very brief medical history before I explain my problem.

This past August (10'), I woke up one morning and my entire left ankle and foot were swollen. It was painful to stand and walk. I waited three days before making an appt. with my DO thinking it would go away. She said I probably just irritated it playing soccer with my son and sent me for an x-ray and bloodwork as precautions. Both came back normal. When the swelling and pain got worse, I went back again and ultrasound. Again came back normal so I made an appt with a podiatrist. The pain and swelling got so bad that I was crawling on my knees to get around my house and working half days at work.

When I finally made it to the podiatrist, he fitted me for a walking boot and said he thought it was an inflammatory arthritis related to my CD. He told me to ice and elevate it as much as possible.

While the boot brought relief temporarily, my ankle became red and hot to the touch however repeated bloodwork came back normal again. At my family docs for a different problem, I showed my ankle to her and she said I had Cellulitis and prescribed an antibiotic. I called the pod for a second opinion and he said to hold off because he didn't think Cellulitis was an accurate dx. I then had an ultrasound which showed severe inflammation around the ankle joint and a ganlion cyst about the size of a marble. The pod withdrew fluid to check for infection and then injected a shot to reduce inflmmation. It didn't help.

Three days later I'm back at the pods and he admits he's never seen anything like this before. My ankle has red splotches that seem to be traveling to different parts of my foot and there is more redness going up the back of my achilles tendon. I then take a tapering dose of prednisone- 60mg and downward which reduces the inflmmation significantly but does not fix the problem.

Three weeks ago I went for a second opinion at the Rothman Clinic in Philadelphia where the doctor told me I have Posterior Tibialis Tendonitis and fitted me with an aircast and told me I'm only to take it off when sleeping or showering. Obviously I do not have a medical background but I don't agree with his dx. I now have a huge knot in the back of my Achilles tendon that swells by the end of the day to the size of a golfball as well as small hard and painful lumps on the top of my outer ankle and a small hard lump on the bottom of my foot near the second and third toes. To top it off, now the instep of my right foot has developed a red hard lump.

I went back to my local pod and he is sending me for a second MRI to rule out an Achilles tendon tear but I don't think that is what it is. I'm at my wits end. I wake up during the night with pain in both feet and can't find a comfortable spot. Please see most recent photos of my ankles attached.

Any advice you have would be more than appreciated.

Kindly,
Erin

Hi Erin,
Unfortunately the photos are of little value to me. One thing I would suggest is if you have all these "knots" for no apparent reason, why not have a needle biopsy to see what they are.
In my opinion if there are multiple nodules chances are they reflect a systemic problem rather than a local problem.
You mention that you have had an ultrasound, I assume that was to rule of phlebitis as that was my first thought as I read through your explanation.
I would also suggest you speak with your doctor who is in charge of your Chron's disease to see if he or she is aware of any manifestation of the disease that may occur in the extremities.
Marc Mitnick DPM