Question about shoes

Posted on May 4th, 2009 by addict

Question about shoes – and how much do you think they can contribute to an ATR. Also, I am seeking recommendations about the best shoes for running, walking, tennis, weights post-ATR.

My ATR happened when I was wearing these Adidas running shoes:

shoes1

shoes2

When I bough them they were supposed to be top of the line, but somehow I think they’ve contributed to my rupture. You see how they hug the heel, extending around the Achilles tendon? This may be completely crazy, but it seems like they have such a secure grip on the heel that they ripped it away from the tendon, with sort of a bottle-opener action.

Is there any merit to this? Should I get rid of these shoes because they caused ATR, or simply brought me bad luck?

4 Comments »

6-month update

Posted on April 21st, 2009 by addict

I’ve just passed the 6-month mark since my ATR, and thought it’s a good time to give an update.

My calf is considerably smaller and weaker on the bad leg. I can do 5-6 heel raises, and only able to lift the heel for about 2 inches. My range is not great on the healthy leg, only about 5 inches, but still much better. I am still doing PT every couple of weeks.

I feel day by day that I am able to walk faster and have less pain in the mornings.

It’s such a relief just to be able to walk normally, even though I can’t play any sports just yet. Just having the hands free from crutches and being able to get my own hot tea is a such a blessing!

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Better late than never - II

Posted on April 15th, 2009 by addict

November 10

 

I hate to be late. I think it’s disrespectful to whomever you’re meeting with, and people who are chronically late don’t get a lot of my respect either. In fact, I’ve never tolerated it even with my dates – I don’t care what their rule book says.

 

Anyway, 3 weeks post-op is my first day in Physical Therapy. Their building is a 2-minute walk away from my office, so I gave myself ample time to get there, and left an hour before my scheduled appointment.

 

I could not concentrate on work anyway — I was really worried – is my Achilles still attached after it was sawn back? It did not hurt at all, pre- or post-surgery, so I was wondering if the surgery had made any difference.

 

It was raining, so I was going to get a cab, but by the time I got to the place where I could catch one, I was halfway there. So I decided to walk it all the way, and arrived soaking wet and about 25 minutes early.

 

Some young girl came out, and said that she’s the new therapist and will be working with me. I went, wait a minute, Sue was personally recommended to me, and I could have come in last week to see someone else, but I waited the whole week to be seen by Sue.

 

But really, I did not want someone inexperienced to do my PT, especially the first session. So I insisted on sticking to the original plan and seeing Sue. Turns out the young girl just was not busy, and only wanted to see me because she did not want me to wait another half an hour. My punctuality backfired, but my paranoia saved the day.

 

I was relieved when I realized that the tendon is indeed attached – when I laid down on my stomach, the foot did not drop like before, but stayed pointed out. Any pressure on the ball of my foot caused excruciating pain in the tendon and the calf.

 

The therapist turned out to be very energetic and confident, and truly impressed me with how detailed she was with her questions.

 

She did some calf stretching, then calf massage (which was very painful as well), then taught me how to put the weight on my boot – completely straighten the bad leg, and really load it, starting from the heel, and rolling forward. I was very tentative before with weight bearing, and was only putting enough weight to support the leg.

 

That’s about it for now. My broadband is still out, so I’ll be posting these later.

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Better late than never

Posted on April 15th, 2009 by addict

Sorry for posting these about 5 months late…

November 3

None of the really successful people I’ve ever dealt with were rushed, egoistic or fidgety.

 

Went to see Mr. Ortho2 to take the cast off.

 

He had me lie on my back, and cut through the bandage (they had put me in a “backslab” – hard cast along the sole of the foot almost up to the knee, and just soft bandage along the front of the leg). The doctor said the wound looks beautiful.

 

When I asked him whether there is any way to check if the tendon is healing and has not re-ruptured, he said it’s too early to tell, and did not attempt to do the Thompson test.

 

He then put me back in the Aircast boot, with 5 wedges, and told me to keep 5 wedges for 2 weeks, and wear the boot day and night, and after 2 weeks to take out one wedge per week, starting from the bottom, and to go ahead and start physio ASAP.

 

He is always in a hurry (more so than your average doctor) – this whole visit must have taken 10 minutes at the most. When I asked whether he used dissolvable or non-dissolvable stiches inside, he mumbled something indiscriminate about how sometimes he uses dissolvable, other times non-dissolvable. Then when I asked him whether I should be doing anything special with the wound when I am taking the bath and stuff like that, he snapped “Mr. Addict, if there were, I would have told you so.”

 

Granted, I do ask a lot of detailed questions, and to some it may come across as doubting, but it’s not doubt – just paranoia I’ve developed after some of the past medical experiences. Perhaps I should have more faith. But then again, as Jack Welch said, the paranoid survives

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Post-op

Posted on October 22nd, 2008 by addict

Hello again!

Well, had surgery on Monday…

Monday, October 20.
Hopped in the cab, got to the doctor’s office around 8am – 45 minutes early! Unbelievably light traffic through Hammersmith and Shepherd’s Bush – a byproduct of the credit crunch, or sheer luck?

His office is in a row of old townhouses, 4-storey tall. There are a few other offices in thee same townhouse, and they all share a reception room with a fireplace downstairs, furnished with antique divans, vases and coffee tables, and with art books laid out throughout.
The office is on the 3rd floor. No big deal – there is a lift in the back of the townhouse. The thing is though that it stops BETWEEN floors. So – you can ride to 3.5 and take a flight of stairs down, or ride to 2.5 and take the stairs up. An odd spot for an orthopedic. He should trade places with the dentist on the ground floor.

Mr. Ortho2 said that there is no question that there is a complete rupture, which he can repair later the same day. I still had my doubts after Mr. Ortho1 being so adamant that there is only a partial rupture, so I insisted on an MRI.

MRI was done by 11am, and they gave me the CD with images to take back to the doctor. So – I gave the CD to Mr. Orhto2’s secretary, and was told to wait downstairs.
Mr. Ortho2 came down 5 minutes later supposedly after taking a look at the MRI, and said that the MRI confirms the complete tear, in the upper 1/3 of the tendon, and once again he recommends surgery, which he is ready to do later the same day.

For the life of me I can’t figure out how can you possibly see the upper 1/3 of the Achilles in these images – looks like they only go a couple of inches above the ankle. I’ve posted my entire MRI here , if anyone is interested.

I’ve grown even more paranoid after my diagnosis changed twice, so here is another question to the group:
Question 2: Can someone point out to me in which particular image can you see the tear?

Anyway, I went along with his recommendation, and checked in for surgery.

They knocked me out around 5pm, and I woke up around 6 with a cast. Spent Monday night in the hospital, checked out yesterday morning, now at home with my leg  propped up on a pile of pillows.

Addict

2 Comments »

Days 1-11

Posted on October 19th, 2008 by addict

Hello all!

I am 36 years old, fairly active, worked out 5 times a week. Blew my Achilles playing tennis – POP, “blow” above my heel, and I am on the ground waiting for an ambulance. This happened around 5:30PM on Thursday, October 9. I was taken to the small injury department in St. Mary’s near Paddington.

There they did the calf squeeze test, and broke the bad news – a complete Achilles tear.

Now, I am new in the UK, and don’t know how to navigate the health system. I am fortunate to have private insurance, which I think may have done me a disservice (read on).

I asked one of the doctors whether I should use my private insurance, and he said that he personally would, so I followed his recommendation. In retrospect, I think I may have been better off going the NHS route, because it’s 10 days later I still don’t know who is going to treat me, where and when.

So – they took X-rays, put a temporary plaster on the front of my leg, told me to expect a call from a doc. All in all, I was in and out of the hospital, on crutches in about 6 hours.

Friday, October 10

I get a phone call from a doc, let’s call him Mr. Spine. Scheduled an appointment for Tuesday, Oct. 14, with a view to do surgery on Wednesday the 15th evening. I looked him up on the web – guess what – he turned out to be a spine surgeon. At this point I may have gotten paranoid, and decided to myself that I am going to get a second opinion from an orthopedic, and quickly booked an appointment (Mr. Ortho1) for early Wednesday the 15th.

Friday was also the 1st day I started running a fever.

Tuesday, October 14

During the appointment, Mr. Spine did not attempt to see the foot because it was covered with temporary plaster. When I asked him about his specialty, he said that he indeed specializes in spine surgery, but Achilles rupture surgery is so simple, he could do it with his eyes closed. But – if I prefer he’ll be happy to hook me up with a lower-limb doc, and immediately proceeded to call the other doc (Mr. Ortho2).

So, somehow I ended up with 2 appointments with 2 Ortho doctors – Wednesday the 15th with Ortho1, and Monday the 20th with Ortho2. This could be a subconscious slip – in my line of work we bid out every job to at least 2 vendors. Now that I think of this, some time off work is not such a bad thing – looks like my work practices are getting too intertwined with my personal character.

I weighed my options, and decided that I’ll pick one of the two Orthopedics to take this forward, and cancelled the Wednesday surgery with Mr. Spine. Perhaps I should have had more confidence in him, and would have been on my path to recovery by now.

Here is what £197 buys you nowadaysWednesday, October 15.

Mr. Ortho1 was a lot more thorough with his investigation – he took the temporary cast off, said that the foot is too swollen to cut it right now – the skin will tend to spread apart after the surgery. He also ordered an ultrasound for Thursday the 16th, and hooked me up with a boot.

Thursday the 16th.

The ultrasound doc told me that I don’t have a complete tear – that I have a complicated partial tear, very inflamed tendon, a lot of damage close to the calf, and a bad case of tendonitis. Now I don’t know whom to believe – the ultrasound doc, or the original ER doc, who did the Thompson test.

This brings me to my first question to the combined wisdom of this board:

Question 1: How is it possible to have a positive Thompson’s test with only a partial rupture?

Mr. Ortho1’s explanation was not convincing – he said that this may be due to pain (what pain?) and swelling. He scheduled a follow-up for Monday the 20th, and said that surgery is not necessary.

So – at this point I have 2 appointments for tomorrow: 1st visit to Ortho2, and a follow-up with Ortho1.

9 Comments »

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  • Smish | May 6th, 2009 | 12:44 pm

    I think bad shoes can contribute to tendonitis/tendonosis but because of the force required to rupture your Achilles, I am not sure your shoes can contribute a whole lot to that. I still don’t wear the shoes I was wearing when I ruptured. Partly because they are soccer/football shoes and I can’t play yet and partly because it is fun to be angry at something. Tee hee! Just joking!

  • annieh | May 6th, 2009 | 12:38 pm

    Well, i was wearing ordinary shoes and just walking, so who knows!, I am wearing the very same shoes today, so should I be extra careful ???

    Annie

  • addict | May 6th, 2009 | 12:12 pm

    Haha, glad someone else is thinking along these lines.

  • ep1977 | May 4th, 2009 | 6:01 pm

    That’s funny that you asked those questions about your shoes. I threw away the nike basketball sneakers I was wearing when I had my ATR because they reminded me of the injury and are bad luck.

  • Doc Ross | October 22nd, 2008 | 4:57 pm

    Addict,

    The image on your post depicts the tear. The tendon is white coming off your heel and you can see where the tear is, it should be continous and yours is obvious. The other images on your link were too dark to actually see. I would do a google search on Ruptured Achilles MRI and I’m sure you’ll be able to find one and then correlate with yours. I actually had them video my surgery, being a Doc I wanted to see details.
    Read as many posts as possible so you’ll get an idea of what’s in store for you.
    Good luck and let us know if you have any other questions

    Doc Ross

  • Richard | October 22nd, 2008 | 2:21 pm

    A,
    Well I’ve had a good look and can’t see anything obvious. A few people on the site have asked for a copy of their operation report. These reports are done by the surgeons either during or just after the procedure - ask for yours that should clear up in your mind exactly whats going or gone on
    Richard

  • addict | October 21st, 2008 | 1:50 pm

    gw0508, read your story - it’s great that you can write with humor about this kind of stuff! Also happy to see that your recovery is going well now, after all that trouble with finding the doctor.

  • addict | October 21st, 2008 | 1:44 pm

    Edforman, thanks for the note, it’s certainly reassuring. Orhto2 said there was no question that there was a complete rupture, and confirmed that ultrasound may be unreliable, if the ends of the tendon are just dangling close to each other.

    I ended up having surgery yesterday, will post more details shortly.

  • gw0508 | October 20th, 2008 | 6:35 am

    Addict,
    Bad luck. I have a similar story. When I got hurt, the urgent care folks said I had a complete rupture. Then it took my insurance guys about 3 weeks to send me a referral to see an orthopedist- a hand specialist! What a zoo. He told me I didn’t tear the Achilles, just a muscle tear and an MRI would be a waste of money. You’ll have to check my blog. It’s a long story. Finally 6 weeks after the injury, I finally saw an orthopedist who knew what he was doing and said he thought it might be a rough surgery & recovery because of scar tissue buildup. I’d been hobbling around for 6 weeks in a boot just like yours! I’d also been doing lots of ice & elevation, foot circles and toe wiggling. The short of it is, once he got in, thankfully, there wasn’t as much scar tissue buildup as he expected. I’m almost 5 weeks from my surgery and am out of my cast & in a boot, going a good part of my day 2 footed! When he did the Thompson test, he suspected I had some attachment as there was a very faint response. He found it hanging by a thread. Good luck on your surgery!

  • edforman | October 20th, 2008 | 2:40 am

    Addict:

    I had a somewhat similar experience. Ortho #1 said complete tear, needs surgery, but humored me and ordered an MRI. MRI read a partial tear with lots of tendonosis. After Ortho #1 took forever to read the MRI and wouldnt return my call, I saw Ortho#2. He said he trusted the Thompson test more than the MRI - MRI could show partial tear even if its just the sheathing that is still intact. Ortho #2 convinced me to do the surgery and reported that I had a complete tear (that had retracted into my calf). Had I not had the surgery, it would not have been good.

    Hope my experience sheds some light…

    Ed

  • Smish | October 19th, 2008 | 4:54 pm

    Addict: Tough questions. All I know is that the report I got from the radiologist that read my MRI gave a different diagnosis than the foot and ankle orthopedic that did my surgery. The radiologist thought a certain finding was a huge issue. The orthopedic said it was no big deal but a different finding was the big issue. I went with the specialist. I have not heard of people having fever with an Achilles rupture but I am not a doctor. I have also heard of people having their Achilles fixed weeks after a rupture and they ended up running and sprinting with the best of them. Good luck!

  • addict | October 19th, 2008 | 4:29 pm

    Smish, thanks for the detailed reply.

    Haha, yes, good drugs is always a silver lining in our situation. However, I hardly have any pain in my foot. So - I take 400 Ibuprofen every 8 hours to control the fever.

    Fever is a weird one - I’ve been running a temperature of up to 40 (104). Ibuprofen brings it down, but then it starts to climb back up again. I have absolutely no other symptoms – no coughing, sore throat, stomach problems – nothing. Just the temperature with the headache and weakness that it brings with it.

    I wake up a couple of times every night, cold and soaking wet. It’s been 10 days now, with no signs of improvement. Some of my friends said that broken bones can sometimes cause temperature. All the doctors are telling me that it is not related to the injury. To me it just seems too coincidental – started at the same time, and I have no other symptoms. Can Achilles rupture cause prolonged fever? Can this be a sign of complications?

    Regarding selecting the doctor – after reading your comments, I feel reassured that dumping the spine doc was the right thing to do.

    On the other hand, as days go by, I am wastin

  • Smish | October 19th, 2008 | 1:29 pm

    Addict: Uh, what was causing you to have a fever? Good job keeping your wits about you. I think I would be crazy by now. First off, who exactly read your ultrasound? Was it a radiologist or an ultrasound tech.? Even then, a radiologist knows a little about a lot of things. A specialist doctor (foot and ankle orthopedist) knows a lot about a few things. An ultrasound tech, (here in the US) knows basic anatomy and physiology and how to safely operate the ultrasound machine. They don’t get a “ton” of medical training here. They shouldn’t be reading an ultrasound at all. My point is this #1) I would NEVER allow a spine doctor to fix my Achilles (well unless we were stranded on a dessert island and he was all I had). #2 What was the education and specialty of the person that actually read your ultrasound? #3) If you do have some tendonitis, there may be an underlying problem that caused your rupture (like equinas) and probably only a foot and ankle specialist would think to look for that.
    I ruptured 2 years ago. I, not knowing, allowed an on call orthopedists to do the reattachment. He got the thing together. The whole proce

    [...]
  • addict | October 19th, 2008 | 1:22 pm

    Hi Richard,

    Thanks for the note - read your story, it really must be crushing to have to go through this all over again.

    Regarding my case — you’re probably right, I should have kept my mouth shut about insurance. It might be just my perception, but I feel a bit like I was caught in the middle of favor trading between doctors.

  • Richard | October 19th, 2008 | 12:20 pm

    Hello addict,
    Bad luck with the injury old boy. You appear to have been caught between a rock and a hard place in terms of who the main organisors of your care are. The issues here are that the boundaries between the private health sector and the NHS are becoming rather blurred - it used to be that they ran independently of each other but now the need for efficiency and sound economics mean that they are increasingly working more closely (I wouldn’t say together ) Retrospectively what you should probably have done is let the NHS deal with it all and used your private insurance to get the best in terms of convenience for you. What I mean by that is many of the surgeons work in both sectors so you could probably have been seen by the same Doc all the way through your process and had the continuity that would have brought ‘

    Don’t be afraid to insist on a clear plan from now on - if you read my blog you’ll see how a bad decision can rebound on you later.

    Good luck, keep in touch.

    Richard