Hi, my story and a few questions

Hi, here’s a bit of background for my situation. 33yrs old played indoor soccer for the first time and not one to back down:) Anyways my co-worker (work function of course) crossed the ball and I took the shot (hit the post) landed weird and thought I sprained my ankle. I figured I was out but for some reason I had no pain and continued to play for another hour when I felt the hit in the back of the leg and of course no one was there. I limped away and drove to a medicentre by my place where I was misdiagnosed and sent home. Thank God for the internet, I was in emergency on Sunday (this initially happening Friday evening) and had surgery the subsequent Saturday (Feb 1st).

My protocol is as follows:
Week1: Splint cast NWB
Week2: Aircast (with 3 Heel wedge=1.8″) NWB
Week3: Aircast PWB 30lbs, end of week take one wedge out
Week4:Aircast PWB 60lbs, end of week take one wedge out
Week5:Aircast PWB 100lbs, end of week take one wedge out
Week6: Aircast FWB

Anyways I was at the end of week four when (semi?)disaster struck. This past Sunday the 2nd I was in my Aircast walking up some stairs and since I was allowed to put 100lbs the next day figured I could try it on the steps. I miscalculated and probably put about 170 lbs (I’m 190lbs) on my toe in the Aircast instead of the heel.

The pain was quite severe and I immediately stopped and continued up the stairs with NWB and sat down. Obviously I am paranoid I re ruptured. I went to the ER and the ER doctor looked at it and said it didn’t look like it ruptured again, but he isn’t an Ortho and a ultrasound should figure it out. The ultrasound was done the next day as they had no one on that night. I explained where the pain was and the ultrasound tech did her thing but couldn’t find anything wrong. Next the Radiologist comes in and does the ultrasound and he says it appears the tendon is intact however it’s hard to tell if damage is done due to my surgery which was 4 weeks prior and it can make the ultrasound reading difficult. Anyways he said he wasn’t positive but it would seem unlikely I would require surgery.

Contacted my ortho surgeon today and he received the ultrasound and the message was relayed to me to put one heel wedge back in and continue protocol as normal until our previously scheduled appointment next Friday and that he didn’t think it was torn.

I have pain/tenderness around the surgery where I felt the pain when I stood on my toe obviously and can feel a bit of blood rushing to it when I stand up (this was previously gone).

My question is, when you rerupture, will I know or will it be some obscure thing like my situation? It hurt and is definitely sore (being over 2 days after the incident) but I didn’t feel the “kick” like initially.

And second of all, I obviously did some damage to it, how to gauge how much damage and what could be the appropriate course of action?

4 Responses to “Hi, my story and a few questions”

  1. Unfortunately it’s not trivial to decide - though I think they should have done a Thomson Test! Post-op patients often have bad adhesions - scar tissue that glues together adjacent layers of tissue that should slide past each other - and slips and falls can break them up. Most false alarms are of that sort, and yours might be.
    Good luck!

  2. Hi Norm, thanks for the reply.

    On another note, I know the the tendon is thinner by the heel and tapers out as it goes up and connects to the calf. My thinking is the smallest cross sectional area would be the most vulnerable to rupture but I could be wrong.

    Wondering if anyone has any info regarding of where an ATR typically occurs? I mean is it closer to the heel or higher up the calf?

  3. Boris, there are ATRs all the way from the heel bone — including “avulsions” that tear off a chip of bone — up to the calf muscle(s). I’m guessing that there’s a kind of flat “normal distribution” (a flat “bell curve”) of frequency vs. location.

    Both of mine were maybe 3-4″ above the top of the heel bone, which I think is the most common spot. There used to be a dominant theory that this spot was rupture-prone because it was the “watershed” between two different blood-supply regions, where the flow stagnated. So that part of the tendon didn’t get its share of flow, oxygen, and “food”, so it weakened then tore. I’m sure lots of out-of-touch experts still tell that story, but I believe some recent studies have disproved it. I don’t recall any of the details, sorry.
    And there seem to be two “heads” of the calf muscle (the Gastroc or Gastrocnemius and the soleus), each with its own connection to the AT.

  4. Interesting. I got someone to do the Thompson test and it looks good. Another question I have is regarding where the original tear was. When I run my finger up my tendon from the heel I can feel a slight divot where I believe the rupture occurred and where it was sutured together, like not a full gap but obviously my tendon is not fully healed circumferentially. I’m five weeks post op, how normal is this and can you guys feel the exact spot where the rip occurred?

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