Most everyone on this site suffers from a very similar injury, the dreaded “Achilles Rupture”. Its one of those injuries that makes itself felt most often amongst people who are attempting to do something to make themselves feel vital again, recover form and grace they lost while they tried to raise their children or their career.
I didn’t suffer anything like this.
I had what is called an Avulsion Fracture of the Achilles tendon. The difference is that while a rupture is a violent partial or complete severing of the Achilles tendon an Avulsion Fracture happens when the tendon dismounts from the bone, often taking pieces of the bone with it.
The standard tests are used in diagnosis, basically gathering the description of the incident, performing a Thompson’s test and then some form of imaging. Its during the imaging stage that an Avulsion Fracture is diagnosed with the Achilles because the presentation of the Avulsion and the Rupture are so similar.
In my case I was misdiagnosed. I hesitate to think that it was because the ultrasound residents weren’t familiar enough to suspect something other than a rupture and more because my injury continued to mislead their diagnostic procedures.
When a tendon avulses (is that a term?) it typically does so because some trauma has weakened the bone to which it is attached and the tendon pulls bone fragments with it. These fragments would of course show up readily in x-ray or ultrasound. In my case the tendon, as my surgeon described it, peeled right off the bone. If you imagine that a typical Avulsion is like removing a price sticker from an expensive gift, mine was like peeling warm wax from glass. The only way the injury could have been diagnosed correctly was by using MRI and the confidence of the diagnosis was so high they didn’t feel it was necessary.
Everyone here is familiar with the two basic treatments available for the Achilles Rupture, surgical treatment where the Achilles is patched together or non-surgical where the patient is placed in a boot or cast with their foot in extreme plantarflexion.
The treatment for an Avulsion Fracture is surgical, the tendon cannot re-attach itself and so the tendon must be forced to assume its original position. This also requires traction in order to counteract the tension placed on the tendon by the muscle. Previously the procedure used included the use of large headed surgical screws but more often the procedure originally developed for dealing with a Haglund’s Deformity is used.
In this case my surgeon ran a whip stitch from the bottom of the tendon up to the bottom of the muscle to act as a platform for the sutures that he would put in place. He then drilled two holes through my calcaneous (heel bone) and out through the bottom of my foot adding two counter sink holes on the outside into which he sunk two suture pins. Then he ran very heavy sutures through the tendon, down through my calcaneous and out through the heel. While keeping my foot in extreme plantar flexion and heavy pressure on the tendon they set the tendon into traction by using a surgical button on the outside of the bottom of my heel. When that was set in place he whip stitched through the tendon and the suture pins, snugging everything in place.
The idea of the surgery is that the tendon will be forced into contact with the bone after appropriate debridement, the tendon is then meant to resume its connection with the heel. There are two other options to this, one is the PBT Transfer where the Achilles is attached to the Peroneus Brevis Tendon or the FHL Tendon Transfer where the tendon used to flex the big toe is detached, fed backwards through the foot and up a channel cut in the calcaneous and the FHL tendon and muscles are stitched to the tendon. (The big toe is then attached to the tendons governing the next toe over.)
As far as I’ve gone with this its successful. I’ve not noticed anything to indicate that the tendon is dismounting again and I’ve still got my full range of motion. Now all I need is to get moving on rebuilding my strength. I may stay away from doing too many jumping exercises but that’s just sensible I think.
Yes, the name I adopted for this site is indeed a pun. Remember, the doctor’s assumed they knew what my injury was (denied) and my tendon is meant to assume on the calcaneous (denied).