Operation Achilles Heel Heal

First of all, many thanks to MaryK, diane, 2ndtime, Ultidad, Kevin, Highflyer, normofthenorth and Frouchie. Whether or not positive thoughts and vibes will result in the accelerated cosmic healing of my achilles, they have helped no end in keeping me chipper.  Thank you.

I went for my follow-up with my surgeon yesterday.  The surgical wound appears to be healing really well - obviously good news.  Those long days of lying down with my leg raised have clearly paid off.

I’ve been put straight in to an Aircast boot with five wedges.  That was a surprise.  He’d told me he wanted to get me in the boot ASAP but I wasn’t expecting it quite so soon.  That said, I am strictly NWB, and have to treat the boot like a cast for four weeks.  That is, no weight at all on it, and avoid taking it off.

After four weeks, I work my way down the wedges over the next eight weeks, allowing weight on it as is comfortable.

This is clearly an aggressive approach.  I had the option of going in to a series of casts over eight weeks, but his reasoning for the boot was that early, small movement and eventually pressure on the tendon encourages stronger healing.  I’m delighted that’s a good option.  I can even loosen the boot to have a good (careful) scratch if needed.

However, it’s all resulted in me “going commando” today. The key question I forgot to ask my surgeon was: How do I get my trousers on and off?

After washing this morning, I carefully took the boot off to get my trousers on.  I managed that before putting the boot on, then realising I hadn’t put my boxers on!  It’s a very precarious affair getting in and out of the boot so that’s how I stayed today.

Apologies for the detail, but it’s my first lesson in my new situation.  Put your boxer shorts on first!

I also discovered last night I’d been given the wrong wedges for my boot. I’ve been given left foot wedges for my right foot.  I didn’t notice in the day, as I’m not putting any weight on the boot.  But they begin to dig in to the outside of your foot when you lie down in the boot.  With Aircast boot wedges, the long bit should be on the instep.  I’m back to the fractures clinic tomorrow to get the right ones.

If it does nothing else for you, an ATR keeps you thinking.  You could say it keeps you on your toes…

I’m sure I’m not the first to use the comparison, but ATR recovery is like a game of snakes and ladders.

Unfortunately I’ve landed on the big snake that takes you back to the start, after suffering a full re-rupture last week.

It was 14 weeks after my ATR playing football.  I went the conservative way and things had been progressing well, apparently.  I’d gone in to the boot before Christmas and then in to two shoes mid Jan.  Indoors I was walking confidently, if with a big limp.

I won’t focus on the gory details but I got up from the sofa last Tuesday in the wrong way, on my toes, and that was that.

It took me a day or two to accept something serious was wrong as I still had good strength in my foot.  The pain hadn’t been severe, there was no ‘pop’, but clearly something had happened.

I went to A&E where an orthopedic chap said he thought I’d redone it so he admitted me.  The next day I saw two consultants.  Both were hopeful I hadn’t done severe damage but wanted an ultrasound to check.  That took a day to arrange with the right person.  It took one second for her to see the full rupture.

So I was in to surgery first thing the next morning - conservative treatment is not the same kind of option second time round.  The Surgery itself was fine (great painkillers!) and once again I’ve been lucky not to suffer too much pain.  My surgeon says it all went to plan and I now need to do what I can to help heal the wound and avoid infection, i.e. don’t move much, no football or pub crawls, and keep my leg up.

I’m staying with my parents for a week while I keep my leg up.  My Mum’s just retired so needs to keep busy to help herself manage the transition to life without work!  I’ll make sure I keep her working with requests for tea and cakes.

The whole event has been odd, to say the least.  It’s been emotionally draining - the thought of going back to square 1.  But I’m working out ways to keep positive.

For starters, it’s a different square 1 and I’m on a different board with new ladders to look for and new snakes to avoid.  Having tried conservative, and now having undergone surgery the injury feels like a different one.

On the note of conservative vs surgery, I wouldn’t urge anyone to use my experience to sway them either way if considering their own treatment.

I don’t regret going conservatively.  I really felt my progress was going well, but I fall in to the 8%/10%/15%/20% (depending on which study you favour) who have been unlucky.  That’s what my surgeon said: “You’re just one of the unlucky ones”.  That was strangely reassuring for some reason.

That said, I now have to put my full confidence in the surgical approach.

I won’t go on now.  There’s plenty of time for that in the next week or two once I’ve got my thoughts together.  As ever, it’s a great help to have somewhere to share this experience.

My cast was taken off last Tuesday, seven weeks and six days after my ATR.  I’ve now got an Aircast boot with one wedge in it.

Just after the cast came off the consultant did the Thompson test and my toes moved, which was quite a relief.  He asked me to push my foot down on his hand, and I was able to put some pressure on.  Likewise lifting it was fine too.  So that was all excellent news, and seemed to show things are going to plan.

My calf muscle is much smaller but there’s still quite a bit of mass there, even if I can’t tense it fully at the moment.

So, I was given an Aircast boot, and told everything looked fine and I was discharged.  I had my physio assessment booked for the next day.

It all felt like great progress, but I left the first physio session feeling confused.  The chap I saw was fine in that he checked the tendon again and was reasonably upbeat about how things were going.  But he wouldn’t give me a good idea on how things might develop from here.

He said the Aircast boot was not totally necessary as I could be doing my PWB in shoes.  This was surprising, but he said I should keep using it until my next appointment, which is on 6th January.    I have a maximum of six sessions on the NHS, but I might only need 2 or 3.

Does that sound right?  I have a sheet with some exercises I can do at home, but I get the feeling from other blogs that some physio is very hands on and more frequent.

Anyway, I am taking it as an indication that things are going well.  But, I’d really like to spend a decent session with a physio who’ll take me through the exercises, and give me strong indication of how much I can push the tendon.  Hopefully that will happen in the new year.

I don’t want to sound like I’m moaning, but some more answers from consultants and physios who are treating me would be very, very welcome.  Thank goodness for this website!  Happy Christmas!

A ‘partial weight bearer’ that is.  Though I’m sure there are more inventive and certainly more offensive possibilities for ‘PWB’.

It’s now six weeks since I suffered my ATR playing football.  After going to A&E immediately I was diagnosed and given the options.  I chose the conservative path.  Yesterday I went in to my fourth cast.

The three previous casts have taken my foot from equinus gradually towards a 90 degree position (I don’t know the fancy name for that) where I can lay my foot flat on the floor.

I’m about 5% off that now.  I was given a kind of shoe, a bit like a flip-flop that an elephant might wear, with straps to keep it attached to the bottom of my dashing blue cast (again Kevin!  I just like blue.).

Anyway, I didn’t see the consultant, but Colin, who put it in plaster, said that I would now be able to put some weight on it.  Initially when standing still, but then I might be able to hobble around unaided!  That was exceptionally good and unexpected news.

Does it make me a PWB?

I think it should!  I’d like to mark the occasion by updating my profile, as I’ve been getting pretty sick of the crutches, and although I’ll still be using them for a while, it would be nice to mark a step towards the day I can throw them out of the window for good.

So, I’ve got the current cast for another two weeks, then I’m into a space boot for a month.  I think this will be the one with the wedges under my heel that are gradually reduced to bring my heel down.

Yesterday my calf muscle was quite a bit smaller than at the previous recasting.  I know this is normal but it was a bit of a shock.  I’ve always been secretly proud of my calf muscles.  I’ve never had much to boast of muscle-wise up top, but thanks to lots of cycling I had developed chiseled calf muscles.  Now I have one that’s got the droopy, squidgy feel of a beer belly.

If I’m good and do what the physiotherapist tells me, how long till I’ve got a nice chunky calf muscle again?

Otherwise, I’ve been bumbling on with work, trying to get out as much as possible, and having dreams where I’m walking only to realise mid-dream that I can’t do that at the moment.   It’s a bit like dreaming of flying.

My girlfriend has been very supportive.  However, I secretly suspect she finds the whole situation agreeable in some respects.  As I said to her the other day: “Every girl wants a temporarily disabled boyfriend don’t they?  So you know where they are all the time, and they aren’t able to go out late and eat kebabs while walking home from the pub.”

Don’t you worry Sarah, I’ll be coming back late with bits of kebab down my shirt before you can say: “Extra chilli sauce please”.

I managed to get back to work today, eight days after the ATR.  I mainly work in an office so should be able to get my job done without any great problems. 

I’ve found that using crutches has become much easier, even after a week.  It’s not necessarily the control, but my stamina seems to have increased so I can go further.  Still, I think a couple of hundred metres is my limit at the moment.

How have others got on with crutches?  Do you find yourself able to go further and stay on them for longer?

Of course, everyone wants to know what I’ve done, which is really nice, of course.  But it can get a bit repetitive.  I’m currently developing three versions of my story. 

The full version, for family, friends,  those who are really interested, or those I think I can get car lifts from in future.

The medium version for most work colleagues.

And the short version for those who are just being polite, or look like they’re in a hurry.  This one is:  “I’ve just stretched some ligaments in my ankle.”

I’ve found the moment you mention the Achilles tendon, people want to know everything.  It’s great as most people have exactly the same reation.  Their lips purse, there’s a sharp intake of breath, the nose scunches up towards the eyes, and the forehead comes out in deep furrows.  It’s what I now call ‘The Achilles Face’, and it’s followed by ‘The Achilles Sound’.  This is a long ‘oooooooooooo’.  Like the vowel in ‘boot’, but longer.  It’s certainly an injury people feel particularly squeamish about.

My next goal is to start exercising what I can.  I obviously won’t be going jogging, but assume I can do other stuff to try and keep in some kind of shape.  I would welcome any advice or suggestions on this as I haven’t read up on it yet.

Just back from the Fracture Clinic at Addenbrookes, having decided to go for the conservative approach. 

With so many studies and accounts to consider it’s not possible to be totally happy with a decision, but that’s it made now and I have to stand by it (assisted by crutches).

The consultant said that while there will be a higher risk of re-rupture, it is still commonly a successful treatment, which would require the same time in cast as having surgery.  I feel comfortable with the advice I’ve been given, though part of me would have preferred them to tell me what to do instead of offering plenty of reasons - any combination of which could have led me down either path.

I’ve spoken to a lot of friends in the last week about the choice I was having to make on surgery.  With few exceptions they’ve said: “I think you should go for the surgery.”  But when I ask them what they are basing that on, no-one has been able to say why.  I think the assumption is that going for surgery is the best option, and you’d only avoid it if you were fearful of it.

I’ve been convinced by the consultants I’ve seen that opting for non-operative treatment is not a cop-out, and rationally it’s as sensible as going for surgery, if for different reason.

If I’m unlucky and it does re-rupture, then I can always go for surgery then. 

So, I’ve got a fancy new hard cast that I’ll wear for the next three weeks.  I chose the white option, though I could have had it black, blue, yellow, or pink! 

When Eric, who put me in cast, took the temporary “back-strap” off, my ankle was swollen, with yellow bruising on the calf and dark red below the ankle.  Didn’t look too bad though.  Scratching my calf for 30 seconds after he took the old one off and got the new one ready almost made this whole ordeal worth it!

I’ll wear this until mid-November, with the toes pointing downwards, then swap it for one where they’re brought up slightly.  I’m looking at eight or nine weeks in plaster, then on to the next step.  I’ll worry about that when it comes.

Some very good news is that I can go back to work when I like, so I’ll see if I can get in later in the week. 

I could do with one of those Segways.  Anyone have one spare?

I suffered a full rupture of my Achilles tendon playing football on Wednesday 21st October. There were no warning signs but as soon as it went I knew what had happened. I’m 32.

I was taken straight to Accident and Emergency, and less than three hours later I was back home in a cast.

The treatment I was given was excellent. But, it was all so quick I didn’t get the chance to ask all the questions I wish I had.

I’m off to the Fractures Clinic tomorrow where hopefully I can get answers to these.

In no order, here are some of the questions I hope to get answered:

1) Should I go for surgery or not? I suspect at my age that would be best, but I was told that both operative and non-operative treatments were decent options - with the understanding that non-operative treatment results in a higher re-rupture rate. However, surgery comes with a risk of complications. How big are these risks?

2) How long will I be immobile for? Will I be able to get back in to work on my crutches soon or not?

3) Will I ever be able to play football again? And when is that likely?

4) When am I likely to be driving again?

5) How is this likely to change my life in the long term? Will I always need to be cautious?

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