Too Much, Too Soon - my Achilles Tendon Rupture

Folks,

I had my frist post Op. last week and was told things had gone well; the surgeon requested I go to the boot but the cast person put me in a 2nd cast for 2 more weeks, to be safe. I should get the boot on Tue 5th Aug and physio starts the next day.

I just read a copy of the surgeons report from that first check and it states that the Simmons test is negative. I read on the internet that the Simmons test is the pinching of the calf to see if the foot twitches (also called the Thompson test).

I assume the result of negative means no twitching of the foot, which is bad isnt it?

Does anyone know if this is a bad sign for recovery?

WEEK-04: My Good Leg Goes Bad

On Thursday after my 1st post Op. check on Monday, 2 wks post Op. and 3 weeks post ATR, my good leg takes a dive.

The strain of constantly having to balance on one leg while washing, preparing food, etc. has caught up with me. My good leg and foot are hurting to the extent I cannot walk on the good leg and can just about stand up.

The good foot hurts along the sole on a thin line; the ankle and lower leg hurt when I walk on the leg and lesser pain when I stand. I think this due to the tensing up they do when Im balancing on the leg to do things; hopefully a couple of days rest will put it right. But now Im totally immobile, chained to my bed, luckily my link to the outside world, my laptop, is close by.

I also think my footwear is a factor; I always wear my slipper indoors and although it has a raised sole like a shoe it doesnt offer much support. From now on I will wear a training shoe indoors.

I am bored, bored, bored.

I have also decided I wont be playing soccer again; I will be at least 43 when Im fully recovered and I never want an ATR again! I may take up coaching a youth team or just have a kick-about with friends at the park. BUt no more twisting and turning for me. I will stick with the gym, jogging, cycling and skipping (when done properly is very low impact, your foot is only an inch off the ground). Or thats how I feel today anyway.

Im hitting the books. I read with interest Kelly Holmes AT episode and recovery. Kelly won 800m & 1500m Olympic golds in 2004 aged 34, but she had many injuries including a torn AT in about July 1997. It wasnt a full blown rupture and was treated in a cast with no surgery. But by end of the year there was no running. The scar later thickened and required surgery to remove some of it. By May the following year she was still not able to run properly (foot locked) and went to see a physio in Limerick, Ireland. After 6 weeks he had her running and she competed in the Commonwealth Games in September (she won a 1500m silver medal), just over 1 year after the AT tear. Part of the physio included massaging her calf with his elbows, which was very painful but paid off in the end.

On a completely different note, I am also fascinated by history and ordered 2 books on the Blitz of my home city Liverpool during WWII. Liverpool was a major port for Atlantic ships and was the most bombed city after London, when Hitler tried to shutdown the ports keeping Britain alive. The worst bombing was in the first week of May 1941, each night 1st - 7th May. The devastation is vast, something like 1,700 killed, 1,100 injured and aout 90,000 people made homeless. My Mother joined the army at 17 as a gun aimer on anti-aircraft guns. How people took such routine devastation for so long is unbelievable and it puts my woes into perspective.

I also have done a little research about my mothers youngest brother who was killed when his merchant boat was torpedoed in 1940. His ship “The Kyleglen” was sunk on December 14th 1940 by U-100 commanded by Joachim Schepke who, although killed when U-100 was sunk on 17th March 1941 (by the first surface ramming using radar guidance), he was the 11th highest U-Boat commander of the war.

When you have a computer and time on your hands its fascinating what you can find out.

On a more uplifting note I am expecting 3 short books including “Treat Yourself To Life” which basically cover concepts for imrpoving your mental awareness and attitude to living.

The NFL isnt renowned for philosophy but I heard something profund one day on a rare TV broadcast in UK. The commentator talking about a player said “In life, its 10% what happens and 90% how you react to it”. How true that is.

Had my first post Op today, 21st July 08, 2 weeks post Op; plaster off and stitches removed. All looked OK. The Consultant wanted to put me in the boot but the guy doing the plastering has replastered my leg; when I asked why he said to protect the scar and I am to come back in 2 weeks for a boot assessment with them. I will see the consultant again in 6 weeks.

Although the boot can be taken off for showering apparently I would still have to sleep with the boot on, which is more bulky and uncomfortable than the plaster (fibreglass actually; very neat and light).

Does anyone sleep with the boot off so soon after first Op? Just curious.

So dissappointed not to get the boot (its seems an ATR recovery milestone) but the surgery & healing seems to have gone well. I actually fell onto my bad leg 2 days after surgery (my first night home) when I slipped on a sink splash in the bathroom. Glad to see thats not done any apparent damage.

I will have an appointment about every 2 weeks  to get the foot adjusted back toward 90deg. Only slight muscle wastage on calf, I was expecting a lot more.

Whats the opinion? Is the boot better than plaster?

I blew my Achilles on 2nd July 2008 at around 6pm, playing football (soccer). By the way, I live in Bristol, UK. This blog will detail how my ATR was treated initially.

If there is more than one way to skin a cat it seems there is a thousand ways to treat an ATR, all based around the same two principles of either wrap the leg in a cast, leave in the oven for about 8 weeks and let it knit itself back together; the other way is to have the Achilles stitched back together in an operation. I guess we all heal differently and I also guess surgeons are like musicians in that when asked to play a tune they will all give a slightly different rendition.

I managed to drive myself home at about 6.30pm, very gingerly and luckily with not far to go. The injury was to my left leg (operating the clutch), so I could brake safely with my right leg. It’s the only time in my life I wished I had an automatic car.

The first thing I did was phone the national health help line. Gave them the gen and the guy confirmed what I dreaded - its probably an ATR, go directly to Hospital and forget about soccer for the next 6 months at least. I called a cab and took a 5 minute ride to the BRI in Bristol centre and reported to the Accident & Emergency unit. Luckily it was not that busy just a few people and one young “VIP” with police officers on either side.

After only about 15minutes I was looked at by a male nurse. He did an examination including the pinch test on the calf; a pinch on my good leg made the attached foot jump, on the bad leg the foot did nothing. It looks like a complete tear I was told. I got to see an orthopaedic doctor at about mid-night; the ATR diagnosis was confirmed and he made an appointment for me to see a Consultant at the hospital 5 days later on Monday.

At this point I was informed about the possible treatments (cast or surgery). Surgery was more robust repair and cast for middle aged dudes (or dudettes) who may not be that active. I was warned of the risks of surgery (infection, not waking up from the anaesthetic type stuff, etc.) but I knew I wanted the best fix possible because I may be past my best but I ain’t ready to became a walking corpse just yet. I also was aware that one treatment (cast) was a heck of a lot simpler and cheaper than the other. Despite the slight feeling of guilt I said I would favour surgery.  My leg was put in a cast, I was given crutches and I went home in a taxi.

Being on crutches is a pain in the rear and being NWB (Non-Weight Bearing) makes it a royal pain in the rear. You all probably know what Im talking about but one of the things I want to get my friends to do is try brushing their teeth while standing on one leg; I bet they don’t finish before they drop the other leg. Swinging through your crutches everywhere you now feel like a jungle chimp swinging through tree’s to get around. Except a chimp is made for it and people aren’t (unless you’re a gymnast, or trapeze act).

So you’re arms that normally only have to carry a couple of shopping bags from the grocery store once per week now have to handle carrying 195lbs of dude (in my case) approximately every other second while in motion. Want to open the window? Swing, swing, swing then jiggle out of your portable “tree’s”, open window, climb back into your “tree’s”, swing, swing, swing back to your seat. That one act has led you to supporting 195lbs 6-7 times in 2 minutes. Its tiring effectively swinging every where. On the plus side, you will have arms like Popeye in no time and can begin a new career as a professional arm wrestler; this may not be what some ladies desire but at least no one will pick on you at the beach.

Its also impossible to do simple everyday things. Want a drink? Fine, hop to the fridge (refrigerator) swinging through you’re “tree’s”. Then stand on one leg, open fridge, get drink pour in glass, put drink back. Hopefully youre quite happy drinking your glass of juice where you stand because you have virtually no way to carry your drink anywhere while swinging on crutches.

I went to work by taxi on the Friday, eager to escape the monotony and isolation of being stuck at home. Got lots of sympathy and help from people in my office. But I couldnt elevate my foot and the toes looked like bananas. I didnt stay long despite my high hopes of doing a full day, saw my boss (who was great in that he didnt try and coerce in me into working too soon) and then I headed home.

I tell you this reaction at work is worth a million. Although I am self employed and dont get paid when Im not working (whatever the reason, sickness or holiday) it was reassuring to know my colleagues and boss recognised my condition. If you have been lucky enough to have lived all your life in such civilised environments its a million miles from some offices I have worked in. Notably a time on a multi-national project on the EU continent when the day before flying to a meeting of my system I was vomiting at work and had trouble standing upright becasue of extreme dizziness. I reported to my immediate manager my condition and that the meeting would need to be postponed. His response was not “get well soon” but “Im not having this!”. “No” I thought, “you are not having this, I am, you idiot, but I really would like you to have it”. Being self employed on contract at the time, with the unspoken threat of having your contract terminated I went to the meeting. Back to the ATR story …

The Consultant was non-too happy with the cast (I dont think my foot was pointing down enough) I told him I wanted surgery (by now I had looked it up on the web; oh yes surgery is statistically by far the better fix but with some extra risks). He took the cast off (good to ditch the weight of the plaster) and sent me home to await his call in next day or so for the surgery. I got the call the next morning.

Had surgery on Tues 8th July 2008.

Coming to after the Op. my eyes where still closed but my hearing was picking up OK. I heard someone close to me say “They think they fractured his left hand in theatre and will take an X-ray”. Then I felt someone slide something under my left hand and everyone was told to stand clear, before it was removed again. When I fully recovered I was in a different part of the hospital away from the Operating Theatre. I heard a staff member whisper over at the side “They dropped him in theatre and thought they fractured his hand”! My left hand was a little swollen on the back but I felt no pain, including from my ATR. In case anyone has visions of 195lb guy plopping on the floor of theatre I should add that for the surgery they had to transfer me to another bed onto my stomach; this bed came while I was knocked out so they would have had to lift me from one bed to another. According to Health & Safety regulations they should have used a fork-lift truck for the load lifted, but they probably managed with a “1-2-3 Lift!”. My guess is they dropped me onto one bed during a transfer; if I’d have made it all they way to the floor I would definitely have more than a swollen left hand. I need to ask about this at my first check on Monday 21st July.
I spent a couple of nights in hospital and was discharged on the Thursday 10th July. Getting a taxi home, I had to keep my left leg off the floor, which wasn’t easy. Luckily it was only a 10minute ride, or would have been if the cab driver hadn’t got a call on his mobile. Having not invested in a hands-free kit the driver pulled over to the side. I figured he would say “call you back” and drive on. Instead he went into detail about the status of his property purchase in Spain. I gave hints about my leg and he kept nodding but he also kept talking. “I need to go home 5 minutes away; call him back before my leg hits the floor and my crutch somehow acquires the exact contours of your amazingly dense head” (OK, I only thought the last part). He nodded again and just as he wrapped-up his Spanish property saga and I thought we would now get under way he chips in “Oh and how are my shares?”. At this point I wanted to be bitten by a radioactive insect and turn into the Incredible Hulk and thus investigate how far his head could travel from his shoulders before he went limp. “I need to go now, call that guy back”. Amazing! Funny when I look back at it, but I wanted to kill him at the time.

So here I am, 2 weeks from ATR and 1.5 weeks from Surgery. I hope they do a thorough check on Monday and can tell me how the Surgery went. Then I will ask about the pain in my left hand (wink, wink!)

Well world, I hope you learn from my mistakes. Anyone reading this is coming from either of two places; you have an ATR (Achilles tendon rupture) and need some company and understanding or you want to learn how an ATR can happen and so prevent it. Its likely to be the former reason but I hope you all pass on this experience to others who may learn from it.

“Learn” is too strong because what I have to say, people probably already know; which makes the point more important because my case is about having the knowledge of how to avoid an ATR but not using it. I hope my experience will lead others to do what they know and avoid an ATR experience; believe me it aint funny.

Heres the scoop: I am 42 years old and all my life I have been physically active. I played Soccer (”football” outside of USA/Canada) to a high standard upto my teens, later became a ski racer when I lived near the Alps for 7 years. I also enjoyed tennis regularly. The last 4 years I did no sport but jogged and bits at the gym. Then in 2007 I did nothing the whole year. I had insomnia and had no energy to do anything. 2008 I was dtermined to come back to life; I began to sleep better and began going to the gym before work to skip, get the lard off and get some stamina.

To anyone not having done it, skipping is a great exercise. You only need to do 10-15 minutes a day for a week to see big improvements. It was fun and I began to skip like a champ (OK, Im exagerating but thats what it felt like).

I now decided to rekindle an old flame that never fully went out; my passion for soccer. I walked away from ths sport at my peak at 17 (thats another story - I had 3 clubs interested in me at the time, Rotherham, Cambridge Utd and Liverpool). Like most kids from a poor inner-city background, soccer was a life saver for me and it meant everything. It was the only light in my life and it was the only source of fun, freedom and I guess expression. And I guess thats how most people feel about doing sports, to some degree or other. Good or bad at it, most people love to do it. Sport feels like sunshine, you cant live without it.

Guys at work were holding weekly soccer games every Wednesday. I played my first game in the last week of June and it felt great. Despite my obvious lack of stamina and speed or the 14 pounds excess baggage I was hauling around, I managed to last a full 90 minutes on a full size field. It was like being born again; all those old instinctive feelings came gushing out and I was hooked again. I knew the stamina and speed would come with more games and I was determined not to miss any.

I played the following week, eager as I had been at 17. But I was about to become my own worst enemy. I got delayed at work and was only able to make the soccer field with about 20 minutes left. I told myself to skip it and wait to the next weeks game. Sound advice that went in one ear and out of the other. I got changed in about 3 seconds flat and made a fatal mistake that I had never made before and knew should be avoided like the plague when playing a sport like soccer.

I didnt do any warm-up or stretching. I cringe now as I write that confession. Yep, I became an eager beaver and ran straight out to the field and started playing soccer. I would go easy I told myself. Such casual disrespect was about to be sorely punished. After about 5 minutes I got the ball with no one near me. I went to turn and make off when my left (standing) leg was hit by sledgehammer from the back. I was convinced a nearby hockey player had hit me with his hard ball, but saw he still had it. I limped off, knowing that this kicking sensation was a tell tale sign of an ATR. I was in pain but not rolling around with agony; the initial explosion was bad but it lessened. Optimistically (OK, I was a blind dumb ass) I hoped it was a bad cramp in the calf; I stood against the wall and did some stretching exercises…

Never, never do a major sport without an adequate warm up or stretching. I dont care if you are playing with your kids, its an absolute fact that top-tuned atheletes can damage themselves if they do not warm up properly, so it can definitely happen to you too.

I have rambled for ages, if any of you made it this far, Thanks for listening. I will keep my future blogs much shorter. I had my operation last week and thats where I will kick off my next blog. Bye for now.