Official Diagnosis

The day after my disastrous episode in A&E I hobbled my way into Nuffield to meet the ankle and foot ortho specialist. I was in there for a good couple of hours and came out feeling a lot more in control than when I went in. He listened to my story - said from how I described it he was 90% sure it was a rupture, took my cast off me and did the calf squeeze test, sure enough no movement in my foot at all. He replaced the cast with an aircast boot with four wedges in it.

We talked at some length about the pro’s and con’s of surgery vs conservative management. He basically said the re-rupture rate reported on the internet currently is widely out of date and there is actually only a couple of percent difference between the two methods. However he did point out that with surgery once you are weight bearing you can rehab harder and faster on it as the tendon has been manually repaired - anyone else had this advice? He also said what he would see as the point of difference is that with conservative treatment you are likely to get up to 95% of your previous strength and function back whereas with surgery you will hopefully get those extra couple of percent. If I wasn’t overly bothered about how my ankle will perform in a sporting arena afterwards I would probably have gone down the conservative method however I play underwater hockey (weird I know - youtube it, it’s the only way you’ll know what i’m talking about!) for Great Britain, you play this with fins so getting full function is my highest priority.

Once I’d decided on the surgery route he discussed how he would go in with the PARS Achilles Jig system. Basically sounds like it minimises the surgery site and complications with scar tissue etc afterwards. He took loads of time to show me videos etc. He also gave me a 6 week course of injections to reduce the risk of blood clots and arranged for an ultrasound a few days later. Because I’d had a long haul flight he wouldn’t operate any sooner than in two weeks time due to the risk of blood clots so surgery was booked for 10th November.

I think up until the point of seeing him I was secretly hoping i’d done anything else to my leg, basically praying I’d broken my ankle. Felt pretty rotten when I left knowing how long I was going to be out for.

I had the scan the following week where they confirmed the tendon was completely ruptured and there was a gap of 1.7cm. I knew from the millions of articles I’d read that this wasn’t too far to operate and at least shouldn’t require a graft.

I’ll post some pics that I took when the cast came off, it’s weird because when I first did it there was minimum swelling and bruising yet for the first two weeks it just kept getting more and more bruised! Was this the same for everyone?

4 Responses to “Official Diagnosis”

  1. You obviously had a much more positive meeting with your NHS doctor than kojak did (see his post here: http://achillesblog.com/kojak/2017/11/21/atr-and-dvt-double-trouble/). I also opted for surgery done with the PARS method and it was easy with little pain afterward. The doctor said it was a good thing I chose surgery because I also had a big gap. So far, my recovery is going well.

    In the “things I never thought I’d google category, underwater hockey seems to be a big deal in Great Britain! With your toe already pointed during recovery, perhaps you could get an orthopedic boot fitted with a fin! Good luck and I hope you return to elite level in underwater hockey soon.

  2. Sadly my NHS experience was equally terrible my follow up the net day was through my private healthcare that I luckily get through work, I had the same ‘we don’t operate’ response as kojak from the NHS team but everything I’ve read and the convos I had with the private dr led me to to believe surgery was definitely the best route for me. How long ago was your surgery? I need to continue updating as I’m not post surgery and the pain has been awful, I have seen him for a follow up today though and he said the ends were absolutely massacred so he’s had to
    Shorten the tendon quite significantly so wondering if that’s increased my pain level (or maybe I’m a wuss!)
    Boot and fin sounds like an excellent idea - will have to suggest at my physio appointment

  3. Sorry to hear there are bumps in the road of your medical journey. My surgery was August 11th, 4 days after my injury. I’m in the U.S. and have a type of insurance that let me choose whether or not to have surgery. Conservative treatment has its advocates (including here at Achilles Blog) but it seems like some cases are better suited to it than others.

    I guess I was lucky in that although my original injury was quite painful once my lower leg was immobilized I had very little pain. I had my leg elevated on the couch or in bed 22 hours a day at first, which was REALLY boring, but the first few weeks after your injury is no time to be a hero. Once I had clearance to be partial weight bearing, I gradually worked my way up to being more mobile again. It’s very slow, but you can look forward to each day being better than the last.

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