ATR and DVT - Double Trouble

Hi fellow sufferers.

Thought I would start up my 1 st blog to share my Achilles rupture experience.

Like many bloggers the problem started with Basketball.

I’ve played since high school and used to be up to county level when TV’s were in black and white.

Our weekly scrimmage was mixed, with a fair number of senior citizens (ok – 50plus). However we then had an influx of young, fast guys and some ex National League heavyweights.

It could only end badly – and it did. Trying to relive the glory days during one intense session resulted in an Achilles fire that would not go away.

Two visits to the doctor led to an appointment for an MRI scan in 6 weeks.

Lesson #1 (which I ignored) – Do not play any sport if your Achilles is telling you things. There is a high price to pay if you carry on regardless.

True – the doctors did not warn me to cease all activities – however I don’t think either of them had ever dealt with an Achilles injury.

My other sport is Volleyball and I play regularily and coach a very promising team.

We participated in an annual local tournament that pits Div 2 and Div 1 teams in the same pools.

My team had finished last in Div2 for 2 years. The first match was against a Div 1 team that had won the league on many occasions – and we were kicking butt!

Youthful exuberance was getting the better of me until an energetic jump was accompanied by a loud snap. Finito…

The local hospital was excellent and identified the problem using the Thomson test, ultrasound scan and X-ray (to identify any fractures).

As I had a history of DVT the hospital gave me two blood thinning stomach injections and told me off severely for not pill popping my Apixaban.

Christmas came early with a nice half cast, pointing down 30deg. and then a discharge home to ponder the errors of my ways.

Next day I had a call to return as the blood tests showed possible blood clotting issues. Another Ultrasound showed 3 historic DVT sites but no current issues.

A week later and it was time for my 1 st appointment at the Fracture Clinic.

All the staff were excellent, apart from the Orthopaedic consultant. He was totally disinterested, monosyllabic and dismissive. His answer to “when can I play Basketball /Volleyball again” was “You’ll never play again”.

When I asked about surgery, his comprehensive reply was “No surgery”.

Researching this site and the Internet pointed to possible reasons for non-surgery:-

  1. Age (although I could not find the magic cut-off point).

  2. History of vascular problems in leg

  3. Diabetes (Not something I am currently blessed with)

    I also suspect that my weight of almost 21stone could have influenced his decision. I will never know as he wasn’t giving away trade secrets.

    The good bit of the visit was that I got a free ski ‘Orthoboot’, with accessories!

    This was set so that the toes point downwards 30deg with a large wedge.

    It’s big and bulky and hogs most of the bed so I have to sleep on the floor.

    It also presents a lot of questions such as do you leave the vacuum at night (yes) and what is the best holding position for healing (vertical/horizontal) and why does it only come in a cheese flavour?

    To cut a long story, I did try and keep fit, even hobbling around the village on one leg and crutches, only missing a parrot. This may have done more harm than good as my one good leg got a pounding.

    By the time the 2nd appointment came around I was in a bad state.

    The AVR leg was ok and the only occasional pain was from the area below the strap across the top of the ankle and what may have been mild gout at the base of the toe.

    The right foot was on fire with what seemed to be gout in the ankle and toes.

    Ten nights passed in agony and very little sleep. My doctor did send over Proton pump inhibitors, Cocodemol and Naproxen. I gave these a miss as Naproxen can inhibit the healing process of the TVR and didn’t like the idea of the proton pump.

    I had to order an ambulance and wheelchair to get to the appointment.

    Upon meeting the consultant his first words were, “What are you doing here? You should have had a scan”. He appeared to have no recollection of our 1st meeting 2 weeks ago, despite the notes on the screen.

    I told him that the scan had been completed and the gap was 17mm.

    His response was “Well there is not much chance of that healing”.

    This is not what I wanted to hear with every aspect of home, career and leisure life on the line.

    I managed to ask him if Naproxen should be taken due with TVR. His response was “It’s up to you”.

    Possibly he had a bus to catch as he dashed out leaving my prepared list of questions unanswered. He did write something on two sheets before he left. A next appointment – set for 3 months time and an instruction line on the recovery sheet for the physio department.

    There was no one in the physio department who knew anything about TVR’s so they told me to make another appointment.

    They also would not adjust the orthoboot, so it looked like my 5hour trip may have been for nothing. Luckily the appliance guys said they would do it. They also spotted that the consultant had written instructions to set the boot to 10deg and not the correct 20deg. This slip could have set back my recovery or even caused a re-rupture.

    In summary, I would say that the best recovery facilitator you can get is yourself.

    I’ve been stuck on the Internet for many hours. There is a mass of information, but digging out the salient points is not easy.

    I’m not saying the following information is necessarily accurate, but this is what I dug out:-

  • <5mm gap is suitable for non-surgical recovery. This is worrying for my 17mm gap.
  • Surgical intervention is best if you are young(ish) without vascular problems and wish to return to sports quickly.
  • The Achilles will never be as good as it was (room for genetic research here!).
  • The NHS is usually superb. However if you get a poor consultant and can afford it then BUPA would be a good investment.

I guess the main questions that myself and possibly many TVR club members want to know is – has the tendon knitted or am I just dragging around this elephant foot for months as a decoration?

The other big question is what percentage of surgical and non-surgical treatments fail – or, to be positive let’s say – work.

I wish everyone well on the road to recovery – keep your spirits up.

2 Responses to “ATR and DVT - Double Trouble”

  1. Welcome to the club to which you don’t want to belong. It seems like the key question is: are you not having surgery because your other health factors preclude it or are you not having surgery because the protocol in the U.K. (and in many other countries) is to try conservative treatment first and only do surgery if it doesn’t work. There are other forum members here from the U.K. - perhaps they can help you navigate the NHS. Is there an ombudsman or similar person who you can call for help with your medical treatment?

    I think the consensus expectation is that one should be able to resume an active lifestyle after 9-12 months with proper treatment. Clearly even your consultant thinks you are not getting proper treatment if they say it will never heal. I hope there is some way for you to be persistent, as it seems like your outcome will be much better if you can change your course of treatment. Good luck to you and keep us posted.

  2. Hey Kojak,

    Just had my surgery Nov. 3 after dealing with repeated microtears in my achilles since 2010. They would never heal. I can relate to listening to your achilles, but even then, rest sometimes does not heal the issue. I did 2 rounds of PT, PRP, and each time it would be good for 8 months, and then a minor activity would cause it to tear. I had a huge lump on the achilles. MRI revealed that I had an actual mid-grade tear. My body would not heal it…so the knife, debridement, slice my calf, and remove plantatar fasciitis. Sometimes your body needs assistance to heal. So after trying the conservative healing approach, sometimes surgery is necessary…and it make take years to make it apparent, as it was in my case. I was really unaware of how complicated and difficult the surgical route would be. However, my tendonitis was so debilitating that I could hardly walk at times. I am a very active person, going to the gym at least 3 times per week for weightlifting and light cardio. Wishing you the best on a speedy recovery.

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