grimfoot’s AchillesBlog

First, thanks to all for their kind words of wisdom on the last post. Sadly the depression etc continues, its very deep rooted now but not really what this blog is for so in future I’ll try not to mention it…

I’ve got my first physio appointment this Friday - an hour’s meeting up at the hospital. I’ve got a reasonable amount of up and down movement (although almost zero strength) but laterally I’d be as well trying to bottle sunshine! Given that my ankles used to be “loose” - a consequence of many sprained ankles through over energetic cross country as a lad - so that I could bend my feet laterally at 90 degrees this is going to be a job of work to loosen up. That’s what they’re paid for of course and I’m determined to follow all instructions to the letter. I’ve had a couple of bouts of over enthusiasm and paid for that later with the foot singing hallelujah so softly, softly…

I’m fairly sure that part of the cause of the initial snap was my calf being over-developed. I think I was using my calves to compensate for not engaging my glutes properly when running, as well as having trainers with a fairly small heel-toe drop. Not minimal, they’re 8mm drop but perhaps less than I actually needed. So, that’s another question for the physio, some exercises or techniques to engage the glutes - and how to tell/what I should feel when they’re working right.

A triste moment on Friday last week. My race number for the half marathon I was meant to be doing this coming weekend dropped through the door. No doubt this will be the year I get accepted for London as well!! Still, if I do, I’ll defer until 2015, another full year of training can only be a good thing. I doubt if I’ll be doing Brighton in 2015 - with an entry fee of over £60 to be paid again even though my place is guaranteed through the deferral system, I think not! That fee pretty much pays for a new pair of trainers!!!

Another appointment today at the hospital. The consultant prodded and massaged the tendon, pronounced herself satisfied and suggested I put the last wedge into my trainer so that I could lose the boot. I did this - then couldn’t get my foot into the trainer! So, the boot stays on. I’m a restless sleeper at the best of times so I’ve to keep wearing it in bed as well Apparently it takes a full 8 weeks from the op for the darned thing to heal fully. I’d rather not risk it, its bad enough having been out of action for so long now without it getting any longer.

Another problem I have is ongoing depression and anxiety. I’ve had a bad 5 years, as soon as I get up I’ve been hit with something else and its all come out in the last 6 months. I’m sure not being able to get out on my own isn’t helping the recovery of my leg or the (lack of) tone in my calf. I’ve been off work (bar 3 days) since March, I’m likely to be signed off for another month later this week. I’m fed up with it, my confidence is shot to pieces. Running was a fairly large plank in the therapy for depression, it was making a big difference - naturally enough that isn’t happening now. I’ll have to build up again once I can with walking and (very) gentle jogging. That suits my eldest daughter who wants to do our local Parkrun - she’s keen on the T-shirt she’ll get once she’s done ten!!

Physio should start in the next couple of weeks. I’m quite looking forwards to having something physical to do, even if its going to hurt quite a lot. I’m also looking for clearance to start playing golf again but that might be a while because of the twist of the right ankle as the club goes through the ball.

So, things go on. Day by day it must be getting bettr, I tell myself that but it isn’t easy

I went to the hospital for my scheduled appointment - the one where I’d been told that one of the wedges would be removed and we’d discuss physio. So, in I went, still in pain just above the wound and round and up through the calf muscle. After 10 minutes sitting in a cubicle a doctor (I assume, he didn’t introduce himself) asked me to remove the boot, took a look at it and

said “right, I think we can get rid of the boot now, you don’t need it any more”. I looked at him quizzically then said that I wasn’t at all comfortable with that idea, that I had only removed the boot briefly to wipe down my leg and that I thought that I was in for a gradual progression, removing one wedge at a time. He looked at my leg again, manipulated my ankle briefly then said he’d get his physio to have a look at it - and off he went, never to be seen again.

Several minutes later the physio popped her head round, asked my name then came in and shut the door over. She poked and prodded the wound site and my calf, moved my foot about, did the Thompson test and made positive noises. I asked her about the boot and she said (much to my relief) that she was going to remove one wedge and put the boot back on. However, before that, she had me perform a simple exercise that was very difficult - a contradiction in terms surely? No, all I had to do was to bend my foot downwards at the ankle then bring it back up to the neutral position. Well, I tried and tried and eventually my foot moved. 5 repetitions later she got me to wiggle my toes a lot. I’ve to repeat that exercise 3 or 4 times a day and I can take the boot off during the day to let my foot air. She was however very pleased that my foot can reach a 90 degree angle with no strain.

I’m very glad I can let it air, the sole of my foot has 4 large blisters (burst) where the skin has become soft through not being walked on and continually moist through being trapped under the gauze. It looks like athlete’s foot but without the itching. She said its quite common in the summer when there is such a large gap between appointments and that it’ll heal on its own.

Next appointment in two weeks time, I’ve to take a shoe with me - exciting huh? She thinks that I’ll be able to ditch the boot at that point with the one remaining wedge going into my trainer. A few weeks ahead of where I thought I was, the pain I’ve been experiencing is due to overuse, I’ve to take it easy and keep my foot elevated when not in use. Woo-hoo!!!!

Went back to my GP on Friday because my school had asked me to get his opinion regarding my return to work. They wanted to know the usual things, whether a return would hinder my recovery, what risks they had to take account of and what adjustments needed making to help me out. All reasonable stuff, no problem with that. After talking to me for a few minutes my GP decided that it was too soon to return to work - 6 weeks post op - so he signed me off until the 19th of this month initially. We’ll see…

I’m concerned because I still have some pain almost all the time from a dull ache to a distinct throbbing if I’ve spent a while moving about. It still affects my sleep, turning over and bumping my leg leads to a literal wake-up call!! I was concerned also about still taking codeine with all the stories you hear about building up a dependency upon it (or other forms of pain relief). The doc said not to be concerned regarding the codeine; that, as it was being used to control pain and I wasn’t exceeding the recommended dose I would be able to taper off it as the pain disappeared. With regard to the pain, he said that he thought I was probably trying to do too much and my body was doing what it’s supposed to - sending pain messages as a signal to back off for a bit.

The calf on my injured leg is decidedly flabby now and noticeably smaller than the other one. I’ve had a bit of a poke and a prod around the top of the damaged achilles - very gently - and there’s a mass of tissue developing that I assume is scar tissue. I’m really looking forwards to working with the physio to reduce and get rid of that. On the plus side (in fact, apart from the pain most of it is positive) the achilles is all in one piece and I can bend my foot about a tiny bit.

Back to the hospital on Tuesday for what should be the removal of the first of the wedges and hopefully the first appointment with a physio. I’ve got the names of a couple of recommended people from some of my running friends that take on NHS cases so I’ll see if I can get referred to one of them. I’ve also had Pilates recommended as a means of gently stretching out the muscle and the tendon so I’m going to look into that. I think there’s some sort of referral to exercise classes that I might be able to get; if so then it would either be free or heavily discounted.

All in all, I don’t really know where I am on the great scale of recovery. I’m pretty sure that the people I’ve seen so far were being conservative in their estimates of the milestones - losing the boot, off crutches and 2 shoes, driving again, exercising again and running again but I’m going to pay attention to what they say - backed up by the excellent advice to be found on this website!! I’ll know more on Tuesday and post again then!!!

Inspired by comments from my earlier post regarding keeping on carrying on, some thoughts on the “smell”.

I’m pretty sure that most of it is from the soft inner boot where it’s absorbed the copious amounts of sweat I seem to produce overnight - and at other times when its hot as it seems to be most of the time. I’ve been giving the foot a daily wipe down with one venture into the mythical realm of soap and water which, as noted, produced a huge amount of dead skin and muck. I don’t know if my experience thus far is atypical, I was at my local fracture clinic at the beginning of August and my next appointment is the 3rd of September - not the 2nd as I said earlier. Others have mentioned being given guidance by the occupational therapist - I’d quite like to see one as I’m desperate to know if I’m doing things right, wrong or inbetween. I don’t want to risk any further damage but I’m being guided by what my body says. In the meantime, I’m sure that people will get used to the aroma of dead animal that may well be emanating from the boot!!

I’ve had a request from my work for guidance from my GP regarding my return to work. They want to know if a return to work will endanger my recovery, what risks might be incurred by the school and what adjustments they might need to make to facilitate my return. This is fine, I don’t know how I feel about it really, the thought of being in a school with 800 plus young people charging about whilst I’m tottering about fills me with dread. Having said that, if I’m set in a room for the day that might not be so bad although it would be problematic getting to and from the staff room. I also have the problem of travelling - the school I work in is 20 miles away from me, I can’t drive and there’s no direct train line - and being a little country village the service is pretty poor anyway. I don’t know if there’s some sort of assistance scheme for transport in this situation, I can’t afford to pay for taxis to the direct station - its £8 each way so £80 per week - and there’s no early morning bus service either. Ah well, let us not get ahead of ourselves, another 10 days before we go back and a lot can happen in that time.

Over a week since I last posted and some progress has been made.

I’m now able to move around fairly comfortably without the crutches although it is rather a “gimp” walk. I notice it when I’ve done too much, it starts to feel very tired and heavy. Decided to do what I could to get the leg clean and non smelly so have wiped it down most days and washed (well away from the wound) with soap and water. Amazing the amount of dead skin and muck that doing that took off. However, despite the inner sock thing, the boot itself is smelling where the material has absorbed the sweat - sweat itself doesn’t smell, its the gases released by the bacteria that feed on the sweat that smells. Its apparently quite unpleasant - I have no sense of smell but my daughters assure me that my leg smells - nice of them eh?

I’ve got two follow up appointments now, one on the 2nd of September where I think they’re going to start removing the wedges one by one and another a week later. Don’t know what that one is for.

So, just keep carrying on I suppose.

Following on from a comment on a previous post - and acting on the advice from the fracture clinic - I went back today to ask about care and attention for the boot and the leg under it.

I had been told previously that I could remove the boot to wipe my leg with baby wipes, that I could shower it I wrapped the leg up well so that no water could get at the wound and that I could get fresh stockingette stuff to pull over my leg so that the boot didn’t start to stink. I’d said on here that the boot was at the tightest setting and it was suggested that I went back and asked for guidance on it. So, I did.

Fracture clinic was busy, no doctors on duty (I didn’t really expect there to be as it’s Saturday) but I was seen quite quickly. The first nurse was very helpful, seemed to understand the problem re smelly leg and offered me a roll of the stuff they put underneath plastered limbs to stop the plaster sticking. She then asked a more senior colleague to come in and discuss the situation with me. This nurse seemed aghast that I had been removing the boot myself and that I had been cleaning the leg - even though I explained that I hadn’t gone anywhere near the wound with them. She told me that I shouldn’t be putting any weight on the boot yet (I had been told at the same clinic by another nurse to start putting weight on it) and that I should be moving much more slowly than I was. She did give me some foam pads to put around the sides of my leg to stop it slipping and cut off about 2 metres of stockingette for me to use under the boot. They had my file with details of the treatment to date but were asking me questions to which I had no answer - perhaps I should have known the name of the surgeon who operated but I met the guy for literally 1 minute on the morning of the surgery and didn’t see him afterwards, other questions were of the same sort of thing.

I’m going to call the clinic on Monday and ask if I can see someone for some definitive guidance. I don’t want to risk any harm, I’m now worried that I might have done some damage through following the advice I was first given. The second nurse suggested that I might need the next size boot down but they aren’t given the keys to the appropriate cupboard so couldn’t help me there, I felt like I was back at school being told off by the headteacher.

All in, I feel pretty bad about things at the moment. My leg hurts a bit - using it too much perhaps? and I feel generally uncomfortable, sticky and messy.

The theme here is one of confusion. I don’t blame the nurses, they’re just doing a job and if I can’t answer their questions that doesn’t help. I would have thought that there would be a note in my file saying what I’d been advised to do - but there didn’t seem to be. Maybe I need to take notes next time I’m in there so that I’ve got a hard copy - and take all the letters from the various places with me as. That sounds like a plan, doesn’t it?

I seem to have jumped the gun a little! I had my first follow up visit last week when the cast and stitches were removed. The nurse warned me that it might feel a bit odd having the stitches out - it was a very strange sensation. I suppose the nearest I can come to describing it would be that it was like the sensation you get when you get a bit of foil on your fillings. Not painful, but not something you’d want to repeat in a hurry. She had to dig around a bit to get all the pieces of the sutures out but it’s healing well - at least on the outside.

I was put into a boot rather than another cast with 4 wedges below the heel - and told to start putting a bit of weight onto the foot. Having the boot, I thought that I’d be able to bathe but was given a categoric no - just in case there’s anything under the surface that hasn’t healed up yet. I can understand this but with the warm weather and the closeness of the atmosphere at night it wouldn’t surprise me if people cross the road when they see me coming. I’m making use of the shower attachment but its not the same as a long wallow with a coffee and a book - and its darned awkward getting in and out of the tub with a bin bag over your leg!!

On the plus side, having the boot and putting weight on it has to be positive, that much nearer being able to get rid of the boot, starting PT and wearing two shoes. It also means of course that I can scratch the itches that inevitably arise when you’ve got some sort of obstacle in the way!!

Its a fine late summer morning here, at this time I was supposed to be out running 7 miles or so as part preparation for a half marathon at the end of September. Unfortunately, the aged achilles had other ideas. As I said in my profile, we were having our annual sports day at the school I teach in. I was persuaded to take part in the staff-student sprint relay so, knowing that I needed to warm up before I even thought about it, I stretched out (dynamic rather than static stretches), did some lunges and jogged across to the start line. I was on the third leg.

As the baton was handed over, I turned my head to face front, focussed on what I was doing and then the earth moved - literally! There was either a hole in the ground or a piece of loose turf because I felt my foot slip and then heard a noise like very loud bubble wrap being popped - and I fell over. It didn’t hurt at all, it was just odd that I couldn’t move my foot and the place where there was usually a piece of fairly taut tissue now felt very soft and spongy. The phys ed staff got an ice pack onto the area and gave me a lift back to the school from where I went to the minor injuries clinic at the local hospital.

The nurse carried out the Thompson test and got no response at all. She had told me what she was looking for and why so I started to get a bit alarmed - but just to check I asked her and she told me that I’d snapped the tendon about 3 to 4 cm above my heel. By now it was 90 minutes since it had happened and it was finally hurting - a lot! She gave me 60mg of codeine and 1g of paracetamol, some sweet biscuits and a large mug of milky coffee to combat the shock (I’d started shaking) and the drop from the adrenaline spike. After that lot, I drifted off on a fluffy cloud whilst she applied plaster to my leg to keep it in the equinus position. She’d contacted another hospital where there was a specialist as she wanted to try and get it stitched up that day. The MMR scan had shown the rupture in all its glory. Sadly, the appropriate consultant wasn’t available so I had to go home - with my packets of codeine and my crutches.

5 days later I went to the fracture clinic where the plaster was removed and I was put into a boot. I was told that I could remove the boot to bathe - so I did! Amazing the amount of dead skin and muck that accumulate even after just 5 days!! 3 days later I got an appointment at yet another local hospital (I’ve been round them all now) - that was then 8 days post rupture. I went in, had the op from 10 am until 12 and then woke up in the recovery room where I had to have some morphine as it was now very painful despite the lingering anaesthetic. Back to the ward, a late lunch, plenty of water and home the same day.

For the first few days I slept downstairs - slept is a bit of a misnomer, it was intermittent at best but it did mean that everyone else was able to sleep without being disturbed by my moans and groans. I then progressed to sleeping in one of the upstairs rooms but on my own so that I could get up if necessary and not disturb anyone and finally back to our normal bed.

It’s now three and a half weeks since it happened. I still have to periodically take painkillers especially if I’ve been out and about. My upper body is developing nicely thank you and I’ve made a start on using our exercise bike to try and maintain some sort of cardio-vascular fitness - whilst keeping the injured foot elevated as much as possible. I find that it aches if I leave it down for too long although reading some of the other posts, I’ve not had it as hard as some - my foot doesn’t balloon if I leave it on the ground, it just hurts quite a lot.

I currently have 4 wedges under my heel, I’m taking some of the weight on it when walking but most of my weight is still supported by the crutches. I don’t know if my doctors are being very conservative but I’ve been told that I’ll be in the boot until at least the end of October, on crutches until after Christmas and not driving until the New Year. Not sure how my school is going to react, the advice from my doctors is to keep it elevated when its not in use and to avoid standing around for long periods of time. As I said above, I’m PWB at the moment so we’ll see how it goes.

It’s really helpful reading what others have to say and the advice from the various sections of the website look great. Certainly has helped since i found this site in keeping my mood up - apart from anything else, I suffer from depression as well so you can imagine…

grimfoot