Jul 22 2010

Progress - and a problem

Published by daviduk at 6:38 pm under Uncategorized

Progressing well, i think. Gym every day, alternating between 60 mins on stationery cycle / 30 mins walking on incline and a mix of stationery cycle / treadmill / upper body weights. The advice from my phyiotherapist today is to add in cross-trainer and leg weights (always keeping damaged leg ‘flat footed’). Still very stiff pre-exercise, and that stiffness is less to do with the achilles and more to do with the rest of the ankle having been immobilised for two sets of rupture treatment.

One problem though. I have an internal stitch which is trying to push through the skin. In itself not a big problem (although extremely tender at the point at which it is trying to push through), except that i suspect there is quite a long piece of stitch under the skin and possibly still anchored at one end. Having had this apparently trying to push through the skin for several weeks, talk is turning to surgical removal. I am not eager to have another (although minor) surgery on the ankle.

Has anyone had similar challenges? Any advice?


8 Responses to “Progress - and a problem”

  1. normofthenorthon 22 Jul 2010 at 7:30 pm

    Check out GerryR’s blog for an extreme case. Getting that damned stitch out is the best thing that happened to him since the moment before his ATR!

    YMMV, of course, but I — clearly a “skip the surgery” advocate — think you should get it removed. Surgically. And sooner will hold you back less than later.

  2. GerryRon 23 Jul 2010 at 12:46 am

    Holy $hit! GET THAT THING OUT OF THERE!!!!!!!! Take it from me, the longer you wait the worse things are likely to get. The back of my ankle was amazingly tender, would seal up and then break open and drain for a couple of weeks and finally just wouldn’t stop draining. I had my fourth surgery on May 20 specifically to remove the internal suture that had created an abscess. Once it was out, I healed up in just a few days and have been going full speed with no pain since about 2 weeks after the surgery. You may have to get another doc to remove it. My original surgeon told me basically that since he had never heard of anyone having problems with internal sutures that he didn’t believe they were causing my problems. The third surgeon said it was essentially all my fault because I refused to be a couch potato. I know that having another surgery is the last thing you want but putting it off in hopes that somehow the problem will resolve itself is really not the answer. There was someone here quite a few months ago who had a piece of suture material actually poke through his skin. If I recall he said it was quite painful.

  3. Smishon 23 Jul 2010 at 1:32 pm

    I had to have an internal group of stitches removed as well. The relief was awesome once they were out. I say get them removed. The constant irritation is not fun. My doctor didn’t act like it was all that unusual. He said the problem for me was that my sutures were made of a material called ethabon (sp) and my body was rejecting them. He cautioned me to never let anybody put ethabon in me for an interal stitch again.

  4. davidukon 23 Jul 2010 at 2:39 pm

    norm / gerryr / smish

    Really appreciate the feedback, thanks! I was hoping the answer would be ‘no problem, leave them alone’ - but deep down i kind of expected the sort of responses you gave. I had dived into GerryR’s blog before, it had slipped my mind that the issue was ’stitch-driven’.

    I don’t believe i have any infection in there at the moment. First thing in the morning, when there is no swelling in my ankle, i can clearly see a small bump on my skin where the end of the stitch is trying to poke through - it’s extremely sensitive on that spot but no wider. Later in the day, when the ankle swells, the ‘bump’ is gone but it seems to me i can feel longer pieces of stitch under the skin. There is some swelling specific to that area, although by definition, given that the stitch is at the place of repair i am unclear as to whether it is normal swelling or directly attributable to irritation caused by the stitch.

    My wound is good - very clean, never had any issues with closure or with the external stitches. My general rehab is going well - although two lots of immobilisation have left me with a stiff ankle which is taken some work to release!

    smish - if it’s not too painful a memory could you elaborate on the type of irritation you were getting prior to removal? Again, not sure what is related to the stitch and what is normal post - surgical recovery discomfort. Clearly the tenderness at the point at which it’s trying to leave my body is directly related, i am getting some general tenderness in the area as well.

    Thanks once agin for your input.


  5. Smishon 23 Jul 2010 at 3:27 pm

    I never had infection either. One of my PT’s was doing deep massage at therapy and the end of the stitch popped through a small bump on my incision line. There was a back surgeon doing rehab in the clinic at the same time with me (He injured his back doing a surgery because he slipped on something on the floor in the OR and then he had to have back surgery! Irony!) and he came over and looked at it. He explained what it was as I had never heard of that before. It is kind of hard to explain the irritaion I felt but it was almost like I could feel them in there and it ached. I was one of those patients that thought if I ignored the leg, the doctors, and the PT, it would all go away and the bad bad dream would end. I finally went to a foot and ankle specialist (different doc) about 20 months post-op because I couldn’t take it anymore. I was still having to ice twice a day even when I sat on my keester the whole day. The new doctor found several structual issues with my Achilles and we decided that I had to have both Achilles reconstructed at that point. We started with my twice previously ruptured one first. It was during that surgery that the doctor found what the sutures were doing to me from the inside out. Even though I was in a lot of pain after that surgery, I knew after the block wore off that those sutures were out. I couldn’t feel them anymore. My rehab for that surgery was also much quicker and easier even though I had had about 3 times more stuff done. If this doesn’t make sense I will try to explain it a different way. I am not the best at explaining something in writing. I noticed a big difference once those things were out. Oddly, I obviously had a different type of suture in there after my reconstruction surgery but those did their job and didn’t bother me at all.

  6. davidukon 23 Jul 2010 at 4:16 pm


    makes absolute sense - thanks. i have the small bump, about 1 centimetre from my incision line. my PT avoids it when massaging - if it gets touched it’s like a red hot needle in my ankle.

    time for a visit to the doctor!


  7. brianwon 09 Aug 2010 at 5:31 pm

    hi david
    i have read your blogs with hope and fear as i think i am at the stage when you reruptured i have had 9 weeks in casts and are now in the boot.
    am worried that i have been doing too much or maybe not enough of the right things i have read a reply from normofthenorth where i follow a protocol from the two week stage and accelerate it a little.
    like you i opted for no surgery and obviously could not do any excercise in the cast apart from toes and knees and i think getting about on crutches gives a full upper body workout
    so now ithink ill try norms protocol and see how it goes
    just a liitle worried about rerupture also my other achilles left leg
    has been very tender throughout treatment
    so will just be extra carefull .
    hope your going on ok

  8. davidukon 09 Aug 2010 at 5:46 pm


    a time of hope and fear!

    Re. your non-ruptured achilles, i originally ruptured my left achilles about 6 weeks after i had strained / pulled my right one. I was gently easing my way back into sport after resting to give my right achilles some healing time, when my left completely ruptured. So, for the first few weeks i was in plaster on my left leg and in fear of going the same way on my right! I have to say that the enforced rest actually helped my right achilles and seems pretty ok now.

    Like you, i missed exercising while immobilised. Crutches did give a good upper body workout, but i also invested in some therabands which i could use sitting down - 30-60 minutes a day of upper body exercises at least gave me the feeling i wasn’t completely a couch potato! I also cut back on food / alcohol, reckoning if i was immobile i needed much fewer calories - consequently i actually lost nearly a stone during my immobilisation!

    With regard to re-rupture, all i can say is be very very careful out of the boot. Mine was a traumatic rerupture - stood on a dog toy in bare feet and went over on my ankle. Just watch what you are doing!

    Since re-rupture and surgical repair i have been hitting the gym hard. Initially mainly cycling, including in the boot, now cycling / treadmill / cross trainer / rower and some weights, including lower leg BUT VERY GENTLY! I am learning to listen to my body and not pushing too hard - frustrating but in the long term sensible. I am up to 60 minutes on the treadmill, walking at about 6km/hour and about 8% incline - occasionally my achilles tells me to quit at 30 mins, which i do and jump on the cycle.

    Aside from the niggling issue of internal stitches which i have mentioned on here, recovery goes ok. I hope to be running in a month or two. My squash team have asked for my availablity for the coming season starting next month - i have given them a resounding NEVER AGAIN!


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