It’s a mystery!
The spot of pain!
So, went back to see the Doctor (last visit was 6 weeks ago to have the boot fitted). This time I arrive in two shoes with the comments from the physio questioning whether the repar is complete. I spend all of 3 minutes with Doctor (a registrar), he looks at my injury says the repair is complete writes on the notes that the physio should continue as planned and that he’ll see me again in 3 months. That was Monday, NHS physio visit on Wednesday seems happy with all that and we continue.
Today I have my regular appointment with the “private” physio. He remains concerned about how weak I appear to be and how there seems little improvement. I explained that maybe because I’ve been walking in 2-shoes for so long I haven’t been as “dedicated” to the exercises as I should have been. However, he brings up the squeeze/Thompson test. On my injured leg you’d be forgiven for thinking I was still ruptured, kneeling on the chair and giving the calf a squeeze produces little movement of the heel. The achilles is definitely repaired (or in continuity to use the Doc’s words). When I do exercises now I get a sharp pain in one spot just on the top of the ankle bone on the right side of my right leg. This “pain” only occurs when I put the injury under load and only lasts whilst I do the exercise and it responds well to a little bit of massage.
So, two questions:
1. Anyone else been repaired and at 9 weeks post-op getting little movment in the heel with the squeeze/Thompson test
2. Anyone else get the “spot” pain I describe above
The only thing I can think of is that years ago I injured my calf muscle (again playing squash) on the same leg, felt like the whack in the leg you get with the achilles but right up in the calf. This was treated with just physio and I considered it all back to normal. I’m wondering if there was something lurking there and with the rupture it has surfaced.
I’m considering booking a private consultants appointment to discuss this, but suspect they’ll just confirm the repair is in place and that I’m weak from the injury and to continue with the physio.
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Thinking out loud and in addition to the questions above. Is there such a thing as too much dorsiflexion? Have I maybe over-stretched the repair too early and therefore the resulting tendon is “too long” and hence the lack of power…
The document here:
http://achillesblog.com/files/2008/03/ewb-maffuli.pdf
says:
“front slab was fashioned so that the patients
were able to plantar flex the ankle fully, but they
could only dorsiflex it to neutral, thus preventing overstretching of the repair.”
Once I was in the boot at 2 weeks I did do some dorsiflexion but always carefully and never more than body told me I could do.
I can’t believe I have over-stretched this as I have nice tight lump of scar tissue on the repair itself, but maybe I have?
Hi Jg,
I still get pain around the heal area when I walk for a long period (20 minutes or so) of time. Massage seems to sort this out. I am 10 weeks post-op today and find that my foot is still week (although getting better with each day). I have noticed that my walking speed seems to have increase with time. I also notice that after a period of inactivity the tendon does feel tight and requires loosening. I also find that the flexibility in my bad ATR leg seems to be better than my good. I can probably dorsiflex slightly more on my bad leg than my good. I have not done the thomson test since the day of my injury - but I do see movement in my foot when I have my leg on my lap and I massage my calf in a certain region.
jgsquash: I don’t know what it would cost you or how hard it would be, but if you can get to a different doc (maybe a specialist) and maybe get an MRI going, that is the only way you are going to know for sure what is going on in there. Your description of weakness and sharp pain when loaded is very similar to how I presented 11 years ago when I did a partial rupture right where my Achilles attaches to my heel bone. It may be nothing but a different phase of healing but I wish I had gone with my gut and gone to a specialist earlier after my full rupture surgery (3 years ago). I just knew there was something wrong but my doc at the time didn’t give me much attention. I waited for 2 years and my new doc (a foot and ankle specialist) knew what was going on right away. He also didn’t try and diagnose me without an MRI either. Good luck! I hope it’s nothing. Keep us posted.
Hi jg,
If you are thinking about having a private consultation with an orthopod - I would recommend the following surgeons who are foot and ankle specialists - based in London. I think they have treated sports personalities in the past. I personally, have not been treated by them - but came across their profiles on google:
1. Mr. James Calder (Consultant at Hampshire Foot & Ankle Centre - I think he also operates (privately) at the Cromwell Hospital in London.
2. Mr. Mark Davies (Consultant at London Foot and Ankle Centre - he operates at the following hospitals in London - St. John and St. Elizabeth (40 Grove End Road, NW8) - London Bridge Hospital (tooley street, SE1).
jg, I would get it checked out asap, doesn’t sound right to me. NHS failed me miserably so I had to go private.
Get a second opinion, if for no other reason than you are troubled by this problem. Too many doubts in your mind at the moment and they need to be cleared. Maybe there is some mild infection there that needs to be treated.
I went Private fortunately I was covered by PPP, saw Dr. Dalal in Manchester, a good man.
Annie
Thanks all. I can’t work out whether I’m worrying unduely and am being impatient or if there’s really something not quite right. Just rang the private secretary to get in (privately) and see the consultant who operated on me (under the NHS) would take until July!
I’m going to have see someone as my concerns are:
- AT elongation and hence squeeze test failure
- my spot pain
Seeing the NHS physio next week to might pursue NHS referral from her back to the consultant which might be quicker!
MRI might be an option but I’d have to have that recommended by a consultant for it to be covered.
Hi JG,
Regarding the Thompson test, try doing it again while lying on your back and your leg up in the air, so that your shin is pointing straight up. Then pull your toes toward your knee, then relax, then squeeze the calf. The squeeze is more likely to work if you start from a slightly dorsiflexed (but relaxed) position like that.
If I’m reading your picture correctly, the pain is off to the side of the Achilles a little bit. The peroneal tendons go through that area, and may be the source of the pain. Perhaps the peroneal tendons got caught in some scar tissue? Maybe you could test this by using your own leg muscles to twist that foot so the ball of the foot goes down, and the little toe comes up (eversion).
Just a thought,
Doug
Hi JG,
If I’m not mistaken, the Tompson test should be done while lying down prone, not kneeling on a chair. The difference is that your knee is straight; the gastrocnemius muscle (the outermost calf muscle) is pulled tighter since its attached to your femur. With your knee bent, only the underlying soleus can really get short enough to pull on your heel, but it is difficult to squeeze the soleus as it is underneath the gastrocnemius.
Anyways, I hope there’s no real problem, as a too-long achilles is bad and you will have difficulty getting full strength from it. I know my surgeon was worried about this and told be not to put any significant load on it for the first 6 weeks.
Thanks for the comments guys. Quick response as I’m about to go out. Doug I think you could be right, the pain is on the outside of the ankle and the peroneal tendons could be the cause. When you say shin pointing straight up do you mean shin facing the ceiling? or the whole leg pointing up in the air so the shin is actually facing behind you as you are lying down. I’ll re-try the test a little later. Part of me thinks I’m ok but part of me thinks something isn’t quite right.
Hi JG,
Yeah, I wasn’t very clear there, was I? I was thinking the whole leg pointing up, so gravity would tend to pull the foot into dorsiflexion and stretch the tendon slightly. As far as the tendon being too long, I guess one way to test that would be have both legs pointing up, flex both calves, and see if the injured foot points upward as much as the other one does. If it can’t, and the tendon doesn’t feel as tight as it should while doing that, maybe it really is too long. I’m a cyclist, so I’m thinking a long tendon would be akin to a stretched brake or derailleur cable that needs tightening up. (Maybe our tendons should have one of those barrel adjusters put in during surgery?) If the peroneal tendons are the source of your pain, everting the foot should hurt.
Doug
thanks for all the comments, a quick update.
1. Lying on my back with my leg straight up as per Doug I get virtually no response on the Thompson squeeze test
2. Sitting on the floor, the injured foot does appear marginally more flexible than the good foot, although I think I’ve always been more flexible on my right side
3. The spot of pain is still there but appears to be easing. Actually the pain is more acute when I roll the foot inwards (is that the opposite of eversion?). I think the theory about the peroneal tendons is a good one.
I have managed to get an appointment privately with the consultant that operated on me for tomorrow so I’ll discuss all three points with him and report back.
I did the Thompson test on myself. I’m at 6 weeks. The injured foot moves about 1/2 the amount of the good foot. I think this may be mostly because the muscle is smaller giving less effect when squeezed (think about the extreme if your muscle was thin like a string - it wouldn’t shorten much when squeezed).
Thanks for confirming my progress to FWB. I can definately stand on the bad leg alone.
Hope your appointment with the specialist goes well tomorrow.