TWANG! One Achilles Tendon Rupture

Picture the scene. It is 30 seconds before the end of a basketball coaching session for 9 to 12 year olds, and a friendly game of ‘killer’ (where you have to score before the person behind you does) is drawing to a close with two Dads left in. One takes a jump shot from the freethrow line which is going left, and so as he lands he pushes off to head after the rebound, but suddenly pulls up, sits down and turns very pale.

That was me on June 10th at St.Crispin’s Leisure Centre in Wokingham. When I felt the pain I thought the guy I was playing against had taken his shot at the same time as me and had landed on the back of my ankle, I turned to actually admonish him for his aggressive play to find there was no one there. Then I assumed someone had shot me in the leg. Then I realised what had happened.

I have friends who have snapped their Achilles, which meant that when I realised my toes wouldn’t lift, I knew exactly what was afoot (no pun intended). The rest of the group came over to see what had happened, but when I said ‘I think my Achilles snapped’ no one would believe me - it all seemed so innocuous. I took my boot and sock off and found that where my lovely tight, twangy Achilles tendon had been, now there was soft, spongy nothingness.

The staff at the sports centre were great and brought my ice and called a paramedic. Apart from the initial pain (and a slight degree of shock) I didn’t feel that bad. When the paramedic arrived and asked if I wanted any pain relief, I said no, and I rated the pain at 4 out of 10.  I was bundled unceremoniously into the back of a Volvo and whisked away to Royal Berks hospital in Reading.

After a short wait in A&E, I was seen by one of the clinical nurses.  She asked me to point my toes, and I could!  She asked me to lift my toes and I could do that too!  ‘The good news’ she said’ is that it hasn’t gone completely’.  Great!  Then she had me kneel on the edge of a chair and squeezed the back of my calf muscle.  Apart from me giving her a quick education in inappropriate vernacular, nothing happened. ‘Oh’ she said, ‘the bad news is that actually, it has gone completely’.

One plastercast later and I was sent home to spend the weekend with my leg up and to come back on Monday for an orthopaedic appointment.

The weekend went by slowly, and I hopped about the house a little, arranging time off work, cancelling a trip to Moscow I was meant to go on the following week and getting chairs into place about the house so I could sit down and do things I would normally do standing up.  I was now in no pain at all, just inconvenienced by the heavy weight attached to my leg that I couldn’t put down.  I spent a lot of the weekend on the Internet reading about Achilles injuries.  Most articles agreed that surgery was the better path, and offered a better repair than sitting it out, despite the risks of infection and so on, so when Monday arrived, I was going in to my appointment ready to demand surgery.

I needn’t have worried for two reasons.  First, my consultant, John, made it clear from the outset that surgery was the primary option, and once the bullet-proof cast I was trapped in was removed, I would be sent for an ultrasound to identify where the damage was, and then we would start to make arrangements, the only reason that they wouldn’t operate on it would be if the break was right at the top of the tendon because stitching tendons back on to muscles doesn’t work.  So I went for my ultrasound (accompanied by more impromptu expletive lessons for the sonographer) and… the second reason I needn’t have worried about the research was that my tendon had snapped right at the top, so no chance of surgery anyway.

Instead, I am in an Aircast for nine weeks.  I am now ten days into my sentence and I have learnt a number of things:-

1) Aircasts are great because they are light and have a sole on the bottom, so whilst you obviously can’t walk, you can rest them on the floor when you are on crutches, rather than having to hold them in the air as you would with a plaster cast.

2) Aircasts are essentially small green houses.  I have no idea if plaster cast would do the same thing, but man my foot is not a pleasant bodypart to be around right now.  I was told not to remove the Aircast under any circumstances… but I was also given a little pump to inflate and deflate the air pockets and a spare sock to go under the cast.  How do I change the sock without removing the cast?  The combination of sock changing and the vague aroma of gorgonzola means my foot is getting a fairly regular (albeit very gentle) wash.

3) crutches and escalators don’t mix.  If you put the sticks on to a moving staircase, they have this not-entirely-surprising habit of setting off without you.

4) Runners and cyclists are evil, psychological villains.  They run and ride past my house, taunting me with their upright, bi-pedal parambulation.  They know they are doing it.  Evil.  This was compounded on Sunday by the staging of a local triathlon (that I came 35th in two years ago) where the cycling route runs past my front door.  It was torture.

5) Aircast plus gout is not good.  Not sure if this is as a result of the foot being in a cast, but I have had a first bout of gout in three years.  Pressure from the cast on my big toe is excruciating.  The ATR is still causing me no pain at all (as long as I keep all weight off of it of course) but the gout…. yowsers!

6) Lego Star Wars may be targetted at children, but Dads can become addicted to it too.

I’ll keep this blog updated with progress, obsessions, irrational ATR related hatreds and general pathos for as long as it takes.  But I can state now, this time next year, it’ll be me cycling past my house doing that triathlon.  That’s the target.

8 Responses to “TWANG! One Achilles Tendon Rupture”

  1. Funny what you said about the chairs. I did that too :) Every room has a chair for me. My family gets sick of the one in the kitchen, but for weeks I sat right there to eat. Can’t carry anything with crutches!! Now that I’m stronger and in a boot, I figured out how to hold something in my hand and swing the crutch under my arm on it’s own. I have a chair in the bathroom so I can rest my knee and dry my hair. You do what you gotta do :)

  2. Love the attitude and the writing style, danair! I think you lucked out by skipping the surgery, personally, though you should try to follow one of the protocols that’s been demonstrated to produce excellent non-inferior-to-surgery results, like bit.ly/UWOProtocol . In that protocol, you’ll be starting PWB, exercise, and PT in a few days, and FWB (”as tolerated”) two weeks later.

    I found sock-changing scary at first, because the NORMAL way to put a sock on involves a lot of heavy-duty toe-pointing (aka “calf pulling at the AT”). Eventually I got so I could do it without excessive worrying.

    Many people (including health professionals) seem to conclude that ATs are NOT completely ruptured if the patient can dorsiflex normally while seated. Wrong! There’s at least one other set of muscle-and-tendon (maybe with “longus” in its name??) that can do that job just fine, as long as you’re not standing on the foot at the time. The Thompson (calf-squeeze) test is the Gold Standard — as is the lifestyle observation that stairs must be climbed with the entire foot placed on the next step, and the weight transferred to the heel of the injured foot! (One of my consultant sports-med surgeons told me that he considers that observation fully diagnostic, without further tests!)

    Please keep ‘em coming, and good luck. And if you can, please install the ATR Timeline Widget so we can all check your basic info quickly.

  3. Good luck with your recovery.

    I can 100% confirm item no. 6 ;)

  4. I too am a Bastketball victim, torn mine in the same place, 6 weeks in a cast and now 4 weeks in an air cast (3 or 4 more to go) But it all feels good, no surgery, just started single leg heel raises at 10 weeks and walking with no crutch in the cast.

    There is light at the end!

    Good luck with all your healing, hang in there and enjoy the lego.

    m

    http://meandmyachilles.wordpress.com/

  5. Great post! so funny. I think the primary key to recovery, aside from patience is a good disposition and lots of humor. You’ve got all that. Cheers on those pesky runners and cyclists who taunt as they whiz by! I guess the most appropriate response is, “Soon, someday, soon!”

  6. “single leg heel raises at 10 weeks” is too scary for me!

  7. sorry should add I use my arms for a bit of support (physio instructions) when doing the single leg heel raises. Still pretty scary mind you.

    good recovery all.

  8. Buenas Noches! I would just like to offer my thanks for the super information contained in this post. I will be coming back to your site for more cool info in the near future.

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