Traumatic Rupture

March 25th, 2014

On December 6, 2013, I went to my high school to play in the alumni basketball game. I was so excited. I had been working out and eating better, so I was in the best shape I had been in since I graduated from college. It was a co-ed game, and before I went into it, I could see that the guys didn’t really trust the girls. I planned for that to change when I went in.

And it did.

I got the ball, burst into the lane past two guys, and went up for a shot. One of the boys fouled me, and I went to the free throw line. Two shots.

I started to sweat. Free throws are not my forte. Two dribbles, breath, and shoot.

The ball swooshed through the net. One point!

I took another deep breath. Two dribbles, breath, and shoot.

The ball swooshed through the net again. Another point! (Internally, I should have known to watch out. I’m not sure I’ve ever made two free throws in a row.)

We ran back up the court. A teammate stole the ball and passed it up the court. Another guy caught the ball. I glided through the lane, caught the ball, and went up for a shot. BLOCKED! But I was quicker. I grabbed my rebound, power dribbled to the other side of the basket, and jumped hard for lay-up. (I can’t remember if I made it or not though my husband says that I did.)

I returned to the court and turned on my left foot to run down the court. Left foot moved; right foot stayed put.

I remember thinking, "Gee, I didn’t realize someone fell on top of my foot." I tried again. It was like my right foot was stapled to the floor. Then, I looked around. No one was near me except for the referee.

I must have looked funny because the referee looked at me and said, "Julie, are you okay?"

"I’m not sure. I think I need to sit."

Official time out.

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I was able to sort of hop on my heel toward the bench. When I got to the bench, another teammate came over. He started to examine my foot. As my husband came over from the bleachers, I looked at the teammate and said. "It’s bad. I know it. I can’t move my foot, but it doesn’t hurt."

As it turned out, my husband knew the teammate, who was an orthopedist. He said, "You’re right. I’m pretty sure that you’ve torn your Achilles’s tendon. Watch."

We watched him squeeze the calf of my left foot, which caused my left toes to move. We watched him squeeze the calf of my right foot, which caused nothing to happen. My right toes were paralyzed.

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The older I get, the more I realize that there are blessings in everything if you can put things into perspective. That night’s blessings involved the fact that my husband, two-year-old son, and mother had ridden with me, and my in-laws had also come. My husband had two options for babysitters right there, so he could take me to the Emergency Room.

We chose to go to Patient First. By the time we got there, I could not walk at all.  An orderly and my husband found a wheelchair for me.

After waiting a while, the doctor said that no X-rays were needed. I needed to visit an orthopedic surgeon as soon as possible. As I left, I read  the prescriptions and visit summary: "Traumatic Rupture of Achilles’s tendon."

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I was able to get an emergency appointment five days later. The surgeon said no MRI was necessary. His assistant said my tear was evident from across the room. Surgery was scheduled for the following Tuesday.

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My surgery was successful. I had a nerve block with my anesthesia, which greatly reduced my pain. (I took my Percocet at night for a while.) The only minor unpleasant part of the experience was when I woke up from surgery, I was vomiting. I suffer from motion sickness anyway, and the anesthesiologist explained that women in my age group are prone to nausea when given anesthesia anyway.

When I returned home, I was in a soft cast/splint, which I stayed in for 10 days, until my post-surgical appointment. At that point, the doctor’s assistant removed my stitches and put me in a hard (lime green cast) for two weeks. Since it was Christmas, another blessing for me was that I could be out for 3 weeks but only have to have sub plans for 4 days.

After another two weeks (1 month after surgery), I returned to the doctor, who took my cast off and said everything looked great. He wrapped my ankle, and then called the bracing department. The woman in the bracing department fitted me into a VacoCast, which is an awesome cast. It is like a reverse air cast, but it is removable. Taking a bath in the tub was so exciting!

Unfortunately, this also turned out to be a really painful experience. My husband and I both understood that we needed to keep the ankle wrap on inside the VacoCast. On the way home, my ankle started to throb. I assumed it was the change in the angle (moving from 30 degrees in cast to 15 degrees in VacoCast). I stayed in this pain for two weeks. I called the bracing woman and she said she’d never heard of anyone being in pain. I even resorted to taking Percocet again at night because the pain was so great. Finally, I developed a blister. When I called the bracing lady again, she said, "Well, yeah, of course you can take the wrap off. You don’t need anything under the boot." Me: REALLY? Why didn’t you say that at first? Or definitely during my first call? As soon as I stopped wearing the wrap, my blister started going away and my pain left. I never have been one to question any medical advice, but after this experience, I will make sure that I ask questions about anything that goes on my foot that I’m not sure about.

During the month I spent at 15 degrees, I started physical therapy. I had to build back all of the muscle in my leg first. I couldn’t believe how quickly it had atrophied.

At two months post-surgery, I returned to the doctor, and my VacoCast was moved to 0 degrees. I was now at "full-weight bearing status." My physical therapist and I developed a strong relationship. We worked hard twice a week, and I faithfully did my exercises at home. At two  months and two weeks, I walked around the hospital (place for rehab) for 5 minutes without boot or crutches. It was exciting! We made a goal to be out of the boot by my 3 month appointment.

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Then, on February 28, while wearing my VacoCast, I walked to the door of my school. It was a wet morning. When I got to the mat outside the door, something happened. I’m not sure whether my toe grabbed the mat or the bottom of boot was wet and skidded, but either way my reflex to catch myself kicked in.

RRRRRRRIIIIIIIIIPPPPPPPPP!!!!!!!!!

The pain was awful. The kids behind me and beside me must have noticed my anguished look (I didn’t say anything.) because they said, "Are you okay, Mrs. T?" "Um…yes?" I was able to get to the elevator and up to my neighbor’s classroom and sit down.

I took my boot off and there was blood on my sock. I could still move my foot, but it didn’t seem like it moved as far as it did the day before.

I called the doctor’s office and thankfully (another blessing) got through to them. They said to put a butterfly dressing on the cut and watch it. I could come in on Monday if I needed to.

Next, I called the school nurse to ask for the butterfly dressing. She came up to my room with it — and workman’s comp. papers. I wasn’t thinking at all about that, but she already had started the process, so I accompanied her to the workman’s comp. examination office. They said I needed to see my surgeon.

I went on Monday. The assistant looked concerned when he examined me. He said I needed to have an MRI, which I did that Saturday.

I returned for the results on Tuesday. The doctor looked at the MRI and then at me. I explained what happened. He said the reflex probably caused my calf muscle to tighten. This force probably caused the partial tear that he saw on the MRI. I had two options: wear the boot for 2 more months and "wait and see" or have surgery again.

Here are the statistics: 40% of people who go the "wait and see" option will tear it again; 6% of people who go the surgery option will tear it again. I’m now in the 6%. And I’m in an even more select group: the doctor said he had not seen a case in which someone re-tore while wearing the boot.

I scheduled surgery again. My second surgery was on March 18 — three months and one day after my first surgery.


6 Responses to “Traumatic Rupture”

  1. cecilia on March 25, 2014 8:49 am

    Hi Julie! A re-tear while wearing a boot is a really scary prospect. I’m glad to hear that you got prompt attention and are back on the road to recovery!

  2. jiothompson on March 25, 2014 8:57 am

    Thank you, Cecilia!

  3. normofthenorth on March 26, 2014 12:21 pm

    Best of luck in the second rehab Julie!
    You write: ‘Here are the statistics: 40% of people who go the “wait and see” option will tear it again; 6% of people who go the surgery option will tear it again.’ But don’t waste your time trying to FIND those statistics, because somebody made them up! There aren’t any solid stats on rerupture treatment, mostly because the numbers are small, Thank Heaven! For initial ruptures, the post-op rerupture rate is almost always <<6%, often 2-3%. And the NON-op rerupture rate, which USED to be 20% or higher in the Bad Old Days of slow “wait and see” “conservative casting” is now ALSO typically in the same 2-3% range in places that use the modern fast protocols that produced those excellent results. bit.ly/UWOProtocol is one of those, and Exeter in UK has another, and a new Irish study has another, with a 2.7% rerupture rate in almost 1000 non-op ATR patients, including some reruptures and several dozen “stale” ruptures! So the REAL statistics have changed a lot in the past 6-7 years, and they’re still changing - but nobody gets their MD or their scalpel taken away because they’ve been ignoring the recent literature. So make sure you keep that new questioning attitude handy!

  4. Minh on April 2, 2014 6:06 pm

    Hi Julie. I just so happened to select and read your blog today. It was so positive before you re-ruptured it. I feel terrible for you and wish you a speedy and uneventful recovery.

    I myself ruptured my left Achilles Tendon in 1998 (summer going into my sophmore year at San Diego State) and recently ruptured my right one on Feb. 28. Both times were while playing basketball. Needless to say, my days on the court are over (not worth it). I had surgery on March 4 and am 5 weeks post-op. I was just put into a walking boot today and was browsing the web to find how others have began rehab.

    Hang tough and tell your husband to take great care of you. My wife has been a saint. I owe her a new purse ;) I hope to read more about your recovery.

    Get well soon!!!

  5. normofthenorth on April 3, 2014 12:54 pm

    Minh, ATRs aren’t the only injuries you can get from basketball, but two of those is almost always the limit. As one guy posted here a couple of years back, “Unless I grow a third wheel, I should be finished with THIS injury!” :-)

  6. sporti on April 3, 2014 7:58 pm

    Julie - my sympathies are with you as well! I cannot imagine the frustration you must have felt by injuring your repair while wearing the boot. Stay strong and best of luck in your second stint at rehab. I look forward to reading more about your progress. Rob

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    I am a twenty-seven-year-old wife, mother, and teacher. I love sports, coffee, and conversation. My faith in Jesus Christ centers my life and helps me to find blessings amidst troubles. I try to put first things first and stay optimistic throughout my life.