The Hayemaker

March 9, 2017

In a selfish way it’s good to know this injury can happen to the pros as well. I was closely following David Haye’s story after he suffered a full rupture in the ring at the weekend. I certainly didn’t carry on for 5 rounds - I just sat down and tried not to puke.

I couldn’t resist watching the slow-mo replay, still makes me cringe though!


Week 12 - Physio

March 9, 2017

Monday was my third physio session. So I was 3 weeks cast + 5 weeks boot + (nearly) 3 weeks in 2 shoes (non-op).

Walking

She had a look at my walking and straight away commented that I was “blocking”. I think this basically means limping where I stop and jerk expecting pain to arrive. She also noted my shoulders were tense as I walked, probably for the same reason.

She got me to try to walk with smaller steps and to try to relax my shoulders, which worked - just made me slower. I’ll have to just try to step faster instead to make up for it!

She also pointed out I wasn’t extending my knee fully on the bad side - which we established was the same thing - me trying to stop before I feel pain. Again walking with smaller steps and trying to remember to extend the knee should help.

Since then I’ve tried to feel what I do with the “good” leg, and realised I sort of can’t remember how to walk “normally” any more! I wonder if I’m also keeping my knee bent because that’s what I did in the boot to overcome the height difference. I looked at some videos of people walking but it seems that knee extension varies between different people.


Some seem to keep the knee bent (top) whilst some look fully extended through most of the step (bottom).

Massage - as long as it’s not the rupture site

I asked here before about massaging the lump on my tendon. I actually rang the fracture clinic and they’d said it was fine (though I was sure I wasn’t talking to someone clinical!). I’d had my girlfriend dig into my soleus a bit, and it did feel better afterwards.

I mentioned this to my PT and she said that as I still shouldn’t be massaging the tendon itself. It will make it feel better apparently, something about triggering pain receptors and releasing endorphins, but that doesn’t mean it’s a good idea!

She palpated the back of my leg and did make a face implying “oh yeah that’s quite a big lump” when she got to the tendon, and found it was very tight around where the tendon meets the soleus a little bit further up (but lower than I thought it would be - around the very bottom of the thin red bits on the image below). This is actually the bit that hurts to palpate, and apparently is fine to massage here, it’s just muscle tightness.

Maybe I mis-heard and it’s not that we can’t massage the Achilles so much as the rupture site specifically.

ROM/Mobility

As before my ankle ROM is the same as the good side except in dorsi-flexion, which is still a few degrees over neutral.

My PT had a good squeeze around my foot and found I was really locked up between the 2nd and 3rd meta-tarsals (so above the middle of the inner arch). She described why she thought that was and it makes total sense to me. When I’ve been walking I try to lock my foot and ankle rigid as I roll towards the toes, again to prevent it dorsi-flexing and triggering pain in the tendon. Sort of imitating walking in the boot again I guess. So I need to try and relax the foot more and let it push off naturally.

Exercises

I mentioned that I’ve been experiencing good days and bad days, and she pointed out that I need to be doing my physio exercises little and often, not in great marathons at the end of the day like I have been!

The physio exercises I’ve been prescribed for the next 10 days (along with normal walking with smaller steps as noted above) are:

Stand on one leg

She asked how I’ve been getting on with this. I’d been building up and was at 3 sets of 20 seconds. Ideally she wants me to build this up to a minute. This morning I managed a whole 2 minute electric toothbrushing session on the bad leg so that’s gone well!

She also asked about standing on one leg with my eyes closed. I can barely do that on the good leg :D I’m going to work on that too, but it’s too early for the bad leg. The good leg I can do 20 seconds on a good day.

Long step walk

Whilst she wants me to take short steps for general walking, she asked me to practice a few long steps at home as part of my physio routine. I think mainly to get over the rigid foot/blocking issue.

She demonstrated this to me - I’d actually say it’s almost like a lunge-walk, just not as deep.

Calf-raises - 2 up/1 down

She also prescribed (bodyweight) calf raises for the first time. I’m to go up on my toes on both feet, then lean my weight to the bad leg and return to ground with the weight on that leg. Apparently this is important in order to trigger eccentric contraction of the calf muscle (which presumably helps to line up the collagen fibres in the tendon). This is quite painful if I try to “fight” the heel drop a lot, but she said it’s OK if I drop quite fast as I’m still creating an eccentric contraction (even if it feels like a really weak contraction to me!)

I do also get a bit of pain as I near the top of the heel raise on the bad side, though that comes and goes.

Overall

Overall she seemed pleased with my progress. I mentioned that I’ve put back over an inch of the 2 inches that I lost on the calf, which apparently is good going at this stage. She asked me to book in in 10 days time since I’m doing quite a lot on it now.


Week 11 - Walking

March 4, 2017

It’s now 10 weeks since the incident (feels like more, Christmas was ages ago!). So I had 3 weeks in a cast, 5 weeks in a boot, and now 2 and a bit weeks in 2 shoes.

I mentioned before, these last 2 weeks have been a bit harder than I expected. Whilst the boot is a pain, especially to sleep in, you get used to being pain free, mobile and “safe” in it. 2 shoes does feel like a bit of a step backwards to begin with.

Starting again

I’ve learned to really appreciate the Victorian era gardens over the road from my flat. This is where I go to stretch my legs at lunchtimes, and every day I try to go a bit further so I know I’m making progress. There’s also a cafe in the middle I go to in order to have a bit more human contact whilst I’ve been stuck at home.

When I first went out in two shoes (with a crutch) I could only make it to the first bench in the gardens. I could see the cafe in the distance but there was no way I could make it.

The next day I put my boot back on, but it was very uncomfortable because my leg was now swollen and hurting, whereas before I could go miles on it. I failed to get to the cafe again. This was pretty disappointing.

Over the next few days I switched back to two crutches (I really didn’t want to go back to the boot). I pushed on to the cafe one day and found that the next I couldn’t make it again. Progress wasn’t linear like it was in the boot. I did notice that the “bad” days were always damp, grey days, so maybe I could blame the weather.

One weekend I got my girlfriend to carry my crutches for me and I managed to walk quite a chunk of the way to the cafe, but the next day it was like I’d gone back a week.

Breakthrough

I started to worry that I was lagging behind on my progress. I remembered that Don from here is a couple of weeks ahead of me and talked about walking miles after 2.5 weeks. At 2 weeks this didn’t seem likely.

However, the day after I finally let my girlfriend massage into the big lump I can now feel on my tendon, I felt a marked improvement. (Fortunately for me she’s just qualified as a soft tissue therapist, I can honestly recommend her!) In the last couple of days I’ve really come on. I take a crutch out with me but find I can just carry it and wobble along for a reasonable distance.

I still seem to waddle side-to-side a lot but it doesn’t feel anywhere near as sketchy as before, and I can brace my ankle as I roll through to the toes without feeling pangs of pain or discomfort.

This morning I even drove myself to get my hair cut, and it felt fine. The feeling of freedom is a hell of a buzz.

I see my physio again on Monday. Last time she was keen that I still wasn’t to do any stretches, and she hasn’t given me anything like heel raises to do yet. Whilst I’ve only seen her twice I feel reassured that she knows what she’s doing. I’m looking forward to seeing what happens next.

Anyone else struggling with two shoes stick at it, it’ll come :)


Week 10 Day 1 - Scar Tissue?

February 23, 2017

I’ve started to really notice a palpable lump on the inside (medial side) of the tendon at about the height of my ankle bone, about the diameter of a grape and fairly firm but painless. It seems to disappear up into my leg when I point my ankle down (plantar flex). I guess this is a ball of scar tissue on the tendon. I haven’t been told to massage anything yet so I’m going to resist the temptation to poke at it!


Week 9 Day 1 - 2 ShOES YEAH!

February 15, 2017

I can take the boot off! These are my first attempts at walking for posterity

…and I can sleep without the boot. Over the moon!

Update

4 days later, what’s up with my right arm! :D


Week 8 Day 7

February 14, 2017

Last day before I go back to hospital. I’m booked in to see the consultant followed by the physio, so I guess things will start happening now. The safety of the boot is nice but it does feel like time to move on.

I know from blogs and videos here that I need to be pretty careful with it at this stage. That said it seems it’s mostly just pot luck as to whether you’ll be one of the 8-20% (depending on who you believe) that land on the snake and go back to square 1 (i.e. suffer a re-rupture). If that happens, I’ll just have to deal with it.

I really hope they tell me I can sleep with the boot off. I haven’t slept well for at least 3 weeks. I’m not sure why as I’m sure I slept OK at first. Now I just wake up after a couple of hours and can’t find a comfortable position with that great lump on my leg.

I actually stood up without the boot on the other day. Not sure if it was advisable really, but I put the bad foot slightly out in front and kept most of my weight on the uninjured foot. I don’t know why I felt the urge to do it, but it felt good :)

I’ve got used to how small my left calf looks now when I take the boot off. There’s still a bit of muscle on the outside calf (lateral gastroc head) but the inside (medial) just seems to have disappeared. Last time I checked it had lost 2 inches compared to the good side, maybe a bit more now. I’m definitely looking forward to getting the green light to try and lift some weight with it, though I guess I shouldn’t get my hopes up!


Week 7 Day 1 - 3rd Wedge Removal Day

February 1, 2017

I bloody love wedge day! I think because it’s a milestone to tick off on the road to recovery.

I went through the whole top or bottom trial process again and ended up removing the bottom wedge (wedge 4 of 5). This leaves wedges 2 and 3. Fairly uneventful really, it’s still comfortable enough and I can still get about without crutches.

I got a quick video trying it out - no shoe so a bit jerky:


Week 6 Day 6 - Contracting the calf - is this thing on?

January 30, 2017

Trying not to contract the calf

I remember at first, when I was in the cast, I was pretty scared of accidentally contracting my calf muscles. In my mind, if it was stitching back together, it would only take a small amount of force to pull the ends apart again. What if I twitched in my sleep?

As the days went by though I began to obsess over the opposite question - what if they’re not joining together at all? I really wanted to contract that calf just gently to see if it caused anything to happen below the rupture site.

When you see images like this it seems baffling that just fixing the ankle downwards would be enough for the ends to meet up properly and join back together.

(I’ve since learned that the tendon is housed in a sheath, I guess that helps keep them lined up. Still seems pretty incredible to me!)

I couldn’t resist testing it, and I found that I could gently press the “pads” of my feet against the bottom of the cast, which was reassuring…Until I remembered that on the morning after I’d ruptured I’d tried exactly the same thing with the same result. That first time I thought maybe this meant it was only a partial rupture, the consultant later pointed out the obvious gap between the tendon ends.

I think what I was feeling was other synergist muscles (posterior tib or peroneals?) contracting, as the pressure was all on one side (I can’t remember which side).

I kept on driving myself mad trying to prove that I could get pressure across all the “pads” and feel the contraction in the main calf muscles. I think I could, but it took a lot of concentration.

Is this thing actually on!?

As time went on and I got into the boot I started to get a bit more confident about trying to contract. But now what I found was - I couldn’t contract it! Has my brain switched it off to protect it, have I just forgotten how to do it? I find this really interesting!

If I really concentrated I think I could contract the soleus muscle, but the gastroc was just hanging there limp.

Physio

Now my physio has asked me to do some very minimal, 5 second contractions twice a day but only with the leg straight and the foot in full plantar-flexion/equinus (out of the boot).

I’m still finding it very difficult to get any obvious contraction in the gastroc this way. She did demonstrate the movement to me but I can’t remember whether my foot was hanging off the end of the bed or not. If I do have my heel pressed against the floor I feel I have more to fight against and I can get a bit more of a contraction, so I guess that’s the way to go. Otherwise it feels like I’m not really achieving anything at all with the exercise.


Week 6 Day 1 - Down to 3 of 5 heel wedges

January 25, 2017

Time to take another wedge out, so I’ve hit the top or bottom dilemma again.

Starting with wedges 2 to 5 (where 2 is now the top wedge). I tried removing number 2 first, but it didn’t feel right. The lip of the 3rd wedge was now under the arch of my foot. I didn’t want to mess about too much as they’re only stuck together with little sticky pads which I can imagine losing their stickiness, but I had to try the alternative. So I put the 2nd wedge back on, pulled the whole lot out and removed the bottom wedge instead. Much better! So I’m now using wedges 2 to 4.

It feels about the same as before under the foot as you’d expect, I’m still standing on wedge 2. It’s more comfortable on the top of the foot though. Now that the whole foot is lower there’s more room to play with under the boot straps.

Like before I felt a bit of a tug on the tendon as I walked so had to use the crutch a bit more to start with, but that didn’t last long.

I also took a picture of my legs whilst the boot was off, just thought it might be interesting to record how much the left gastroc atrophies over time. Excuse the hairy legs.


Week 5 Day 7 - Start Physiotherapy

January 24, 2017

Today I got to meet my physio for the first time. She explained there’s not much we can do until I’m out of the boot, but I got some basic exercises to do and a lot of useful info.

Stretching?

My ankle dorsiflexion (i.e. pulling the toes towards the knee) is still pretty limited. When I take the boot off I find I can get to somewhere between the red and orange lines in the picture below before I feel a tug on the tendon. I’ve been wondering if it’s worth gently stretching the calf in order to try to get that range of motion back…

Today I learned I should NOT to try and stretch the tendon. At all!

No stretching then

The way she explained it was to think of the gap between the tendon ends as a pothole in the road. Essentially my body has done a quick cowboy repair on the pothole, filling it with rough gravel and tar (scar tissue) just in case I need to use it to run away from a lion or something. The proper job of laying nice fresh tarmac (collagen fibres?) and smoothing it all out takes months and can’t be rushed.

If I try to stretch it now, I could end up with an elongated tendon. The problem would be that when the calf muscles started to contract, they’d just be reeling up slack in the tendon rather than doing their job of pulling on the heel bone and lifting weight.

There would then be a limited amount of contraction left in the calf muscles to actually move the ankle. I’d end up with permanent weakness in push-off and landing on that side, and probably pain in the calf muscles from having to remain contracted all the time.

Mobility exercises

Six times a day I should get my foot out of the boot and move the ankle the following ways

  • Plantarflexion
  • Dorsiflexion (As much as I can anyway, and very gently, no stretching!)
  • Eversion
  • Inversion

I think basically these are to ensure my ankle stays mobile and doesn’t seize up through lack of use.

Strengthening exercises

Twice a day I need to get out of the boot, lay my leg out in front of me, and at full plantarflexion (so toes already pointing away), try to contract my calf for 5 seconds at a time, as pain allows. 2 or 3 reps at first but I can build up adding one rep at a time as long as it’s not painful or swollen.

If it does cause pain/swelling that’s fine, but I need to skip it for the next day to allow recovery before hitting it again.

I think this one is try to stop my calf muscles wasting away completely and to encourage the tendon to build fibres in the right alignment for a strong repair.

The good leg

We also talked about the importance of looking after the good side, as it’s now doing extra work and it’s already starting to feel bad again. So keep stretching that one and doing balancing exercises, one-legged calf-raises etc.

She agreed that I’ve most likely got some bio-mechanical/movement issue that’s damaging both tendons and has led to this result. Obviously I want to try to avoid snapping the other side as well.