Chocolata’s AchillesBlog

My moving from UK to Japan went well in April - about 10 weeks after my ATR. I traveled in the AirCast boot with 2 crutches. Thanks to my husband, I flew in business class and could keep my leg up all the time

One week after my arrival, I had to move to Tokyo from my hometown to take up my new job. The first month in Japan was really hectic; I had to do everything by myself because my husband had to remain in the UK because of his business and my new job involved long commute - 2 hour each way!

Although I managed to ditch the AirCast boot in week 14, I had to keep using one crutch till several weeks ago. As you may know, passengers on a packed metro were like animals, pushing each other to make their way to get out/in the train. I was once knock over and fell over on other passengers’ lap, who were sitting in a priority seat! It was a really scary experience

Norm, thanks for your messages. I wanted to post a note here earlier, but I was too tired to do anything since I moved to Japan. After giving 3-4 lectures a day, my foot swollen a lot and all my energy was drained on commute. In April and May, I was like a zombi everyday after coming home from work. Even at weekends, all I could do was to rest and to do preparation for my classes

This is my 20th week from ATR. I forgot to count the number since I started walking without the boot at the end of May - around the 15th week. I started cooking properly from time to time at weekends, while during weekdays having nice ready-made dishes which were warmed up in a microwave with some salad. I love cooking, but I really didn’t have energy to stand in the kitchen after work for a long time.

For my recovery, I can do 2-heel raise now. I must say my recovery has been in a slow lane, but I am pleased that I can walk without any support

In Tokyo I’ve met up with 11 Japanese who had ruptured their AT, with whom I had exchanged comments via a site over the Internet while I was staying in the UK. At the meeting we shared more information about our rehabilitation programmes and it was great to talk with them in person! One of them suggested to make a web page showing our AT and everyone agreed to have their AT photo taken

It’s time I went to bed. I will try to post more later.

Happy healing, everyone!

Hi guys,

Have you heard the term ‘Judo therapy’ before?

Yes, it has something to do with the Japan’s traditional marshal art - Judo - now an Olympic event. What if I tell you that I’ve decided to see a Judo therapist in Japan for my further ATR treatment? Don’t worry! I haven’t gone mad (yet) and am not going to take Judo lessons as a means to cure my AT.

Judo therapists (JTs) are called ‘hone-tsugi’ (bone setter) in colloquial Japanese. They must acquire a state license and their treatment is covered by the national health-insurance program without a referral from a physician, since Judo therapy is understood to be proper medical treatment.

Judo therapists (JTs) use techniques similar to ones used by physiotherapists (PTs). For example, JTs provide “noninvasive treatment” to treat damage of bones, joints, muscles and soft tissues (including AT) without surgery. Juso therapy is based on Japanese traditional medicine and Judo therapy skills, which have been popular and trusted by peple from a long time ago, and Western medical knowledge as well. However, JTs are not allowed to run X-rays and operations on any parts of patients’ body　and they have to refer patients to a doctor where necessary. One big difference between JTs and PTs is that JTs can run their own clinic, while PTs are not allowed to do so.

As you know, ‘Judo’ or ‘Jujutsu’ (art of softness, or way of yielding) is a collective name for Japanese martial art styles (originally including unarmed and armed techniques). It employed comprehensive combat techniques for defeating enemies, while the techniques were also used to cure the wounded. For instance, old Judo or Jujutsu masters cured injury which occurred during training and they were good osteopaths. 　

After Kano Jigoro (1860-1938), the founder of Kodokan Judo, elaborated judo from Jujutsu in the Meiji Period (1868-1912), Judo masters appealed to the government to officially approve them to practice Judo therapy so that they could earn their living. Their requested was granted and the first Judo therapist license was issued in 1920. Nowadays, one doesn’t need to be a Judo master to be a Judo therapist, but lots of skills practiced by old Judo masters have been handed down over the years.

I’m now in the week 5 of my ATR treatment (non-surgical) and I can’t wait to see the Judo therapist I have contacted by email. His blog (in Japanese) includes some information about the treatment protocol he uses for his ATR patients and it is quite ‘aggressive’. The treatment is named ‘Hoko-ryoho’ (Walking Treatment). Patients are put in a series of special cut casts with a raised heel for about 6 weeks (with different angle ankle) and they are encouraged to walk ‘bowlegged’　from Day 1. They receive treatment using low frequency ultrasonic wave for the first 2-3 weeks after the injury to facilitate healing of their AT. Under this protocol, patients can do double leg toe raise in 3 months after ATR and single one in 5 months.

It’s obvious I cannot follow this protocol, but I’m glad I’ve found his clinic which is not very far from the flat I will be renting in Japan. I can tell from his blog that he is interested in improving his practice. He has been a great listener and has given me useful advice since I contacted him a week before. In the UK I have never had MRI and ultrasound scans to check exactly where and how badly I ruptured my AT and no examination was done by a doctor when they removed the previous cast before putting me in another cast. When I told my Judo therapist so, he understands my worries and has booked a MRI scan at a hospital near his clinic to examine my AT before starting the therapy, so that we can start my rehabilitation as soon as I return to Japan.

I’m also looking forward to my next appointment at the clinic in the UK because they will finally put me in a boot! Once in the boot, I will be on PWB and can carry a cup of coffee from one room to another room - one of my little dreams will come true.

Happy healing, and have a nice week, everyone!

Norm has given me lots of useful information about both hinging (e.g. the MC Walker) and non-hinging boots (e.g. Aircast) for ATR treatment. (You can see the post at http://AchillesBlog.com/chocolata/2010/03/02/3-weeks-after-my-atr/#comments.) Especially after reading the following part, I came to think that the hinged one was more suitable for me.

Norm> The hinging just makes your gait a little more natural and realistic,
Norm> especially as your calf strength builds up. (I’m still working on that,
Norm> though in shoes this time. 8 yrs ago, I did it all in the hinged boot,
Norm> ’til I could “push off” normally again.)

However, I’ve found out a boot I will be given from my NHS clinic is Aircast and have been wondering how unnatural/unrealistic/uncomfortable it can be to walk in the non-hinged boot as my calf strength builds up.

It is unfortunate the clinic uses only the non-hinging boot and it was too much to ask to extend their tight budget to get me a hinged one. Once I get the Aircast boot in 2 weeks time, I will be PWB. I’m not sure how long it will take until my calf builds up enough muscles to “push off normally”, but I guess 1-2 moths may be necessary in my case because my bad foot will be immobilized in the cast a little over 6 weeks.

I will be teaching a few classes a day Mondays through Fridays at a university and can sit down from time to time while teaching. My working environment is relatively safe, but commuting requires me 30-minutes walk in total at each end and 1-hour train ride with one change in the rush hour. If walking in the hinged boot is MUCH easier as my calf strength builds up, I wouldn’t mind to invest in one even if I won’t use it for a long time. I want to make my transition from the boot to 2 shoes safer and less scary.

Could you share your boot experience with me? Comments from both those who have used both types and those have used only one are appreciated.

Hi there!

I’m so glad to tell you that I’m going to get a boot in 2 weeks time!!!

I’m under the NHS treatment in the UK (non-surgical) and boots are not used for ATR patients at my clinic. So I had to ask for one to make my life easier. I’m flying to Japan in 3 weeks time to work there for a few months and it is a must to have either a boot or a cut-cast when I fly. Another reason for my request is that a number of boot users have told me that a boot is more comfortable and better than a cast. I have to start commuting for 1.5 hours by train and walk from Week 10 and good protection is need to make my commuting safer.

When I was at the clinic this afternoon, the cast technician told me that a boot was more expensive than a cast and ATR patients usually won’t get one, but that my circumstance would justify the request. He then said that “Leave it to me” and sent someone to get the approval. I had this conversation while the technician was removing my cast which was put 4 weeks before. I expected an examination by a doctor, but the technician told me that I was seeing one after he put me in a new cast.

When he removed the cast, my poor calf caught my eyes. I knew it, but it was a bit shocking to confirm that. Next moment, I was surprised because the technician was sprinkling white talcum powder over my lower leg! He said it’d reduce smell if I’d sweat in the cast. If I had been in Japan, I’d have got a big tub of nice hot water to soak my foot. Oh, well… I can live without the wash for another 2 weeks.

Without knowing my big disappointment, the technician continued his job. He told me to pull my toes towards me and I tried it hard, but it was not enough. He then put elastic cotton cloth around my lower leg and foot and told me to pull the further end towards me. I did so slowly feeling tightness in my AT area as I pull it. The technician said feeling that way was a good sign. Having achieved the right ankle angle, he started rolling that warm bandage over my foot and lower leg (with my ankle at semi-equinus position). While he was doing so, I felt pains in my AT area, but pains faded away gradually after he finished the job.

We then waited for 5 minutes or so and Dr. A walked into the cast room. He didn’t ask me anything about my AT, but did asked a few questions trying to find an excuse not to give me a boot. I was well prepared for this and managed to persuade him to give me one!!
Thank you very much for the useful input I got from your guys here.

Norm - I especially thank you for your detailed information about different kinds of boots and for sharing your experiences in two of them!

The boot I will get in two weeks time is called “moon boot” at the clinic. It is the AirCast boot. I prefer to the MC Walker boot with a adjustable hinge to the rigid one (AirCast), but I decided to take the offer! The cast technician told me that he had ruptured his AT one year ago and knew what was going through. He smiled at me behind the doctor when the doctor was signing the document to order a moon boot for me.

Anne - I’m glad you’ve got a boot! I will get there - partial weight bearing - in two weeks! Enjoy the freedom you’ve got and keep us informed.

Norm - thanks for the useful tips for novice boot users! I will remember them when I’m in a boot.

Hi there!

Good news - I managed to find a way to insert a photo in my post!

I know some of you have seen my new shoes, but can’t help showing them off again!

I’m bringing them with me to the clinic this Wednesday. I should find out exactly what they are going to do to my dear shoes . hmm…

Here is how I inserted the photo in this post, just in case some of you might have got stuck with the same problem.

After uploading the photo onto my “Media Library” following the instruction in the HELP section, I used the “HTML” editing mode to insert the photo. (I still cannot do this using the “Visual” editing mode.) I know little about HTML and all I did was to copy the photo’s address stored in my “Media Library” and pasted it in a small pop-up window after hitting “img” tab above the text edit box.

—————

If you have tried above, but were unable to insert a picture, you may want to try the following. This time I have taken a detailed note of the steps I followed to insert a picture. Hope this helps!

1. Choose “HTML” mode when you edit your post (or post new one).
2. Click a small round mark next to “Add Media” shown above the edit box.
(It’s right above “link” shown in blue.)
3. A pop-up window opens. Click “Media Library” tab.
4. Choose a photo by clicking “Show” and you’ll see another pop-up window.
5. In the “Description” you can see an address of the chosen photo. Copy it.
(e.g. http://AchillesBlog.com/chocolata/files/2010/03/shoes.jpg)
6. Close the pop-up window by cliking “x” at the top right to go back to the edit page.
7. Place a cursor in the edit box where you want to insert the photo.
8. Click “img” and you’ll see a small pop-up window.
9. In the window paste the file address.
10. Another pop-up window appears to type in the photo description. Type something (e.g. “My new shoes”) and click “OK”.
11. You should be able to see a command line to insert the photo in the edit box.
12. Click “Preview” on the right side of the edit box. The photo should appear in the post!

Good luck!

I had a big adventure yesterday.

I got out of my flat for the first time since my last visit to the clinic about 3.5 weeks before and went into the city centre with my husband to buy a pair of shoes for myself!!

When I was at the clinic last time (2 days after the rupture), the cast technician told me to bring a shoe (for the ATR foot) with me on the next appointment, so that they could put some wedges onto the sole.  I don’t know if they put wedges inside or outside (or both) of my shoes, but the soles should have wide flat heals to allow me to walk safely in them after ditching the final cast or a boot.

Unfortunately, I don’t have any suitable shoes for this because I flew to Britain in my long boots with a pair of flamenco shoes in my suitcase.   I told my husband last week that I wanted to go shopping to buy new shoes, but he thought I was not ready for long distance walk with crutches.  Indeed, good shoe shops are in the city centre and its traffic has been disturbed by prolonging road work and only buses and taxis are allowed to drive on the major streets in the city centre.

To persuade him to take me to my favorite shoe shop, I went online to make sure that I didn’t need to walk a lot if we took a taxi.  I needed new shoes and it was the reason for my first adventure, but there was another reason.  I really wanted to get out of the flat after spending nearly 4 weeks house bound after the injury!  I managed to persuade my husband yesterday and we called a taxi.  Time for shopping!  

The weather was not bad and I put on a pair of black trousers (boot-cut) over the cast.  I also put on my favorite necklace to cheer up myself!  To get out of my flat, I had to walk down the 66 stairs in a Victorian tenement with 1 crutch under my right arm while holding the stair rail in my left hand.  I was excited and going down the stairs was rather fun!

In the UK taxis usually have a high floor and I had to use my arms, hands and knees to get in the cabin like a spider woman!  Once in the taxi, I was like a tourist looking out the buildings and people on the street.  Everything looked lively to my eyes.  About 10-minutes ride took us to a street near the Ecco shoe shop.   No car was allowed to enter some parts of the street, but the taxi driver managed to drop us only 8 metres away from the shop!  (Coolkiwi - thanks for your comments.  I read them after I came home from the shopping, but I smiled a lot when I found out that I had done the things you had recommended!)

I got off the taxi and saw myself standing in the shopping district.  How nice!   The ground was dry and the street was not so busy.  I felt safe to walk with crutches and made my way to the shop.  I had checked their stock in advance and they brought me a few pairs which I had asked them by phone to put aside for me.   The shopkeeper was helpful and offered me a stool to put up my foot in the cast while she was fitting a shoe on the other foot.  Some other customers looked a bit surprised to see me walking with effort to try out a new shoe.  They gave me a space to walk around and I thanked them.

After trying 7 pairs of shoes, I bought a pair with shock-absorbing soles and wide heals.  They were easy to put on and off with Velcros, yet nice-looking!  I took their photo wanted to show you the shoes and tried to insert its photo last night without success.  I could upload a photo onto my Media Library, but nothing happened when I tried to insert the photo into post.  I read the HELP section again and followed the instructions, but the problem remained.  The same problem had been reported by frouchie in the FAQ section, which doesn’t seem to have been solved either.  I’ve reported my problem in the same section and should wait and see if dennis could help us out with the problem.

(You can see my new shoes at http://achilles2010.blog129.fc2.com/blog-entry-6.html 

After the successful shopping, I suggested my husband to have something to drink in a cafe.  He agreed.  I ordered a cup of cappuccino.  We shared a hot panini with mozzarella and sun-dried tomatoes.  It was so nice to be in the lively cafe.

How’s your weekend?

I wish you all happy healing!

Since I ruptured my AT, I’ve been housebound  for 3 weeks, except one visit to the Orthopedic outpatients to have the first half A&E plaster replaced with a proper cast 2 days after the rupture.  I’m still in the same cast and there is one more week to go.

Nothing much has changed, but over the last 3 weeks I’ve made some progress.   For example, my arm muscles seem to have grown a bit and they are not sore when I walk with crutches.  Although I still need my husband’s assistance when I get in/out of the shower cube, I can now cope with more house chores than in Week 1-2.  Having said that, let me tell some of you guys who have been looking after your kids while you are in a cast/boot, I do admire you! 

Yesterday, I found out more of my treatment protocol when I called the Orthopedic Outpatients.   I called them to ask about what kind of cast/brace I’d be wearing in Week 8 because I was going to fly to Japan then.  As you may know, the airlines require passengers like me to put on either a boot or a CUT cast (to allow for quick removal if swelling occurs).

A nurse who answered my call told me that they’d put me in another below knee cast (in semi-equinus position) on my next appointment and that I’d be in it for 2-4 weeks and that boots were not used for ATR treatment.  I wanted hear more about the following protocol, but she told me to ask the secretary further questions because she was not sure if my cast would be cut one when I’d be on board.  And then, the nurse put me through to the secretary, but what I heard on the phone was more than 10 ringing and the following recorded message that the secretary was not in on Mondays.  Yes, it was Monday when I called.  Great.

I’m going to call the secretary tomorrow morning to request a boot.  As some of you wrote somewhere else, boots seem more comfortable and better than casts for patients in Week 5 and onward.   If it is with a hinge, one can use it from Week 5 for sure.

After arriving in Japan, I will be sending out my stuff from my home town to Tokyo and need good protection around my AT while doing the preparation in Week 8 & 9.  Moreover, I will start working in Tokyo from Week 10 and have to commute by train (1 hour with 1 change) and by walk (10- & 15-minute walk) in the rush hour.  Many hospitals in Japan provide ATR patients with a boot, but it takes 1-2 weeks to get one, since braces are usually made-to-order there, believe or not.  So it’s better to get one in the UK before my departure.

In the UK some NHS hospitals use boots for ATR treatment, while some don’t.  I don’t why, but I assume it has something to do with the budget.  I wouldn’t mind to purchase a boot on my own expense, if the hospital won’t get me one.  I’ve actually found a few Internet shops which sell the public several kinds of boots, such as MC Walker and Air Cast.  The best scenario for me is that I can get one from the hospital, but if it’s not possible, I want them to allow me to buy a boot by myself so that I can ask them to adjust it at a right angle for me.  Am I asking too much?

Oh, well.. I’ll leave this to rest until next morning.

Earlier in this post, I wrote how helpful my husband had been, but forgot to mention one thing.   Every evening since I ruptured my AT, he prepared dinner and brought it to me on a tray like a battler.  I’m hoping he will keep this nice service even after I ditch crutches. 

(I know I’m asking too much here!)

DAY 2

When I woke up, I confirmed that I had ruptured my right AT last night.   It was not the night dream, unfortunately.  As far as I sat on the sofa with my right leg up, it didn’t hurt.  I could move the toes up and down slowly with no pain.

However, later the evening I felt numbness in the big toe.   The edge of the half cast was pressing my foot.  I tried to lower my big toe as much as could while sitting on the sofa to release the pressure.   I went to bed about 11 pm.  I was so sleepy, since I couldn’t sleep well last night because of the nausea caused by the laughing gas (and shock from the injury?) .   At night I was woken up many times by massive pains in the foot, especially in my big toe.   I changed my sleeping position to avoid further pains and struggled all the night.

DAY 3

Early in the morning I got up in tears and sat down on the sofa.  I put up my foot higher than the heart, but the pains didn’t go away.   My husband woke up a little later and came to check on me.  "How are you feeling?", he asked.  No word came out of my mouth because of the pains and worries.  I explained the problem to him and burst into crying.  He checked the cast and my toes and we decided to call the Orthopedic Outpatient to request re-casting.   I had to walk down the many stairs with a crutch again (from the 3rd floor, in USA 4th floor), but it didn’t discourage me to go to the hospital.

I saw a doctor in the afternoon.  Before seeing him, I was taken to the cast room in a wheel chair.  There were two technicians (I still don’t know how to call them!).   One of them asked me what’s wrong with the cast and I explained.  He told me that they didn’t have professionals for casting at their A&E and that’s why I got the half cast which was not appropriate for the ATR.

A doctor walked into the room and I repeated the same thing.  The half cast was removed immediately and two red spots were observed around the root of my big toe.  When the doctor touched them, tears welled up in my eyes.  The pains gradually eased down.  The technician put a glass fiber cast gently on my foot/leg and gave me a candy!   I suppose I looked so poor to his eyes.   The new cast was comfortable with round edges.  It covered around the foot/leg (under the knee) and my AT was not exposed anymore.  Here is a question.  Why didn’t I get the proper cast in the first place?   A English friend of mine told me that this was because I was treated at A&E.  To me and my husband, it didn’t make sense.   Casting should be done properly in the first place at any hospitals.

On this visit, I think the doctor spent 3-4 minutes with me in total.  After the initial cast was removed, he looked at my AT and said that it was ruptured.  Nothing new to me.   He then told me to make an appointment in 4 weeks time and walked away in haste without giving me a chance to ask questions.   I think I looked puzzled then.  This visit was supposed to be an opportunity to hear about my treatment protocol, wasn’t it?

The technician helped me to move from the chair used for casting to the wheel chair.   He showed me how to insert a crutch under the seat to make a space to put my injured foot on it.  This nice chap then told me to bring a shoe for my ATR foot with me to my next appointment so that they could prepare wedges to put onto the shoe.   I wanted to know more about the suggested supporting gears but didn’t have time to ask questions because the next patient was coming into the room.

I went home in my husband’s car where the long stairs were waiting for me.  My arm muscles are not strong and pushing up the crutch to carry up my body is more demanding than going down.  As far as there is a rail to hold on to, I think going down with one crutch is much easier.

With the new cast, smiles are back on my face!

Hi,

I ruptured my right Achilles 16 days ago dancing in a lesson.  So my next few entries will be retrospective for a while.

It was a very cold evening and I walked to the class for 10 minutes.   There were about 17 people in the studio and everyone was looking forward to the the first class for their first performance opportunity as part of a professional production at a Victorian theatre.   Dancing is my pastime, and I was supposed to be one of volunteer dancers required for the play scheduled for March.

It was around 6 pm and the temperature was below zero outside.  I changed my clothes and did some warm-up (about 10 minutes) with other students in the studio.   We then jumped gently about 10 cm high and I heard that infamous sound in my right Achilles.   I landed on the other foot and sat down on the floor.  The teacher standing a few metres away ran toward me and I asked her to call an ambulance for me.  She said she also heard the ‘pop’.  I then asked my classmates to carry me out of the studio so that they could continue the lesson.   The staff brought me a blanket and a pillow and stayed with me.  I was sitting on the fancy glass floor in the corridor and it was very cold, but I didn’t notice it was deriving my body temperature.

Paramedics arrived in 15 minutes or so.   They suggested me to inhale laughing gas before transport to reduce pains which could be caused by bumpy old streets.  I inhaled it for a while and then felt nausea.   I couldn’t keep my head up and couldn’t hold my tears.  I was sad about my poor condition.  One of the paramedics told me it was the gas’s side effect and would disappear soon.

When I arrived A&E, I saw my husband standing by the entrance and felt relieved.  While waiting for my turn to see a doctor, my husband tried to cheer me up.  Forty minutes later, a doctor came to my bed and told me to stand on my left foot with my right knee on a stool.  He touched my right calf on the stool and pronounced that my AT was rupture and that it would take 12 weeks to heal.   He then ordered a technician to put an under knee half plaster cast (with a ballerina toe) on my foot/leg.

The doctor told my husband to make an appointment for me with the Orthopedic Outpatient Unit in 1 weeks time.   The doctor then asked me if I had any questions and I asked if they would perform surgery on my ATR.  He answered that the surgery would involve some problems, such as infection and other complications, and they normally wouldn’t go for it with ATR.   I had heard lots about MRSA problems at hospitals and didn’t want to have an operation there.  So the given treatment was fine by me, but I felt something chilly in my spine when the doctor went on to tell me as follows:

"Don’t worry!  If your AT doesn’t heal, we will connect it by surgery later."

I screamed in my mind - "No, that’s the last thing I want to hear!!"

I’ve lived in the UK long enough to learn how to deal with various sorts of hassles in every day life, such as writing complaint letters to British Gas, Royal Mail, and airline companies to get basic/proper services and phoning up a tradesman to get a job done in time.   My English is far from native speakers’, but I can enjoy a little chat with people talking in a local dialect while standing in a long queue!  However, when it comes to the NHS services, I still don’t know much about them.  So I felt desperate for further information about my treatment protocol, but the doctor didn’t have more time for me.

By the time I was told to go home by the technician who put the half cast, I was feeling nausea and couldn’t think anything in order.   On my way home from A&E, I vomited many times and used up all my energy.  On top of that, I had to walk up stairs with crutches to the 3rd floor (in USA  4th floor!) to reach my bed.   This was the moment that I realised what would be waiting for me in my future - no easy access to outside

Oh, well… What’s been done is done.  Let’s look at the bright side!  I tried to talk to myself but couldn’t see any light then.

More stories later!

Dennis - Thank you very much again for creating my blog account!