Tendonosis Troubles

AT Injury – Feb/08
First AT surgery – March 19/09

My Achilles recovery journey didn’t start out like most of the injuries on this website. Mine started with a gradual soreness in my right Achilles tendon that in a few short months got progressively worse.

February 2008
In February of 2008 I started a work assignment that was a more physical job than what I had been used to. There was an increase in the amount of walking and stairs that I had to climb. Working in an industrial environment the terrain can be very rough to walk on and the snow and ice doesn’t help matters either. After a few weeks on this new assignment, my 48 year old body was showing signs of wear and tear and my right Achilles was starting to get real sore. I thought since I had started a more physical job I was bound to be sore and that the tendons and muscles would feel better in time.

March 2008
In March I took a 3 week holiday and I was still having pain so it was off to the family doctor who said, “Ice it, keep it elevated and take some pain medication”. That’s what I already was doing. 2 weeks later, I’m back even sorer than before and now I’ve got this lump in the back of my tendon. He said, “You need some Physio on it”, so off I go and make an appointment with the Physiotherapist.

April 2008
I continue to work during this time but by the end of my shifts I could barely walk and was limping quite noticeably. I can’t think of any one thing I did to hurt it but I can recall a hundred times I got a pain in my AT. The morning of April 18, 2008 is forever etched in my mind as it was the day when the tendon said it had enough. When I got of bed that morning and my right foot touch the floor it felt like a bomb exploded in the back of my leg.  It so happened to be the same day as my first Physio appointment. I hobbled into Physio and the therapist was shocked by the swelling and the lump in my tendon. She didn’t think I had an ATR but severe tendonitis. The outcome of this visit was me getting an Aircast and not being able to do my job for a while. I saw the company doctor later that day and he didn’t think it was ruptured upon examination. Work was excellent about accommodating with light duty work so I didn’t miss any time at that time
As for my rehab I spent the next 12 weeks with my leg in the Aircast, doing some stationary cycling and acupuncture with electronic muscle stimulation. I wasn’t making a lot of improvement as I still had a lot of swelling, pain and the lump in my tendon was the size of a golf ball now.

May 2008
I had an Ultrasound done May 24, 2008, to see what was going on with it and the results came back and said I had mild tendonitis, with a thickening of the tendon.
June 2008
In June I saw another doctor at work for a second opinion and he suggested to me to stop the acupuncture as he didn’t think it was an effective treatment and wanted me to start Ultra-sound therapy. Following his recommendations I started with a new Physiotherapist for the Ultra sound therapy in June/08. I was still having lots of pain and swelling. I was still wearing the big Aircast at this time but this therapist recommended me wearing a smaller version of the Aircast and walking with a cane. We tried the Ultrasound for 6 weeks and I was worse off than when I started. At this point I can’t do any strengthening exercises as the sharp stabbing pain going through my tendon is too much to bear. Most days I’m wearing the big Aircast again to get some relief but it wasn’t much help.

August 2008
The physiotherapist talked me into having Low Level Intensity Laser treatments as she said studies have shown that this type of treatment has been successful on tendonitis. I was willing to try anything at this point in time. When following up with the company doctor as he had taken the primary physician role, he ordered an MRI and I got an appointment for the first part of September. I continued on with the laser treatment but still no improvement.

September 2008
I had the MRI done and the results said that there was a longitudal non-surfacing tear in the tendon with moderate tendonosis. Hurray, an answer finally to why it isn’t getting any better. I’m thinking now I’ll get something done to fix it. The doctor at work referred me to a specialist who I thought was a surgeon but I would be wrong.

October 2008
I saw the specialist in October and she recommended for me to get fitted with a custom orthotic brace. Apparently she didn’t have the results of my MRI and she wasn’t taking my word that I had a tear in the tendon. She said that if there is a tear there is a protocol that they follow before surgery is even considered and surgery only as a last resort and I’m not quite there but close. I was a bit upset with her because I told her I thought I was following protocol by wearing an Aircast and walking with a cane for the better part of 7 months but she didn’t listen to me.

November 2008
I had a cast of my leg taken to make the brace and I started wearing it at the end of November. It didn’t help too much and now my hip was starting to hurt because I’m doing the penguin waddle. I had to buy shoes that were 3 sizes too big so I could get the shoe on over the brace. It was easier to walk with it than without it though. Stairs were easier as the brace took the strain rather than my tendon. I finally gave up on Physio and the laser treatments in November after 33 treatments with no improvement.

January 2009
I went back to the specialist in January and she had a copy of my MRI from last September. I told her there was no improvement in my tendon and she said, “You have a tear in your tendon, you need to see a surgeon. No amount of Physio is going to heal that.” I was referred to a Foot & Ankle specialist in Toronto.

March 2009
I got in to see the surgeon on March 2/09. I spent about 2 minutes in his office and had the papers signed and had a surgery date less than 3 weeks away. He said it has to be operated on as it won’t get any better. He was going to do a debridement of the tendon.
March 19/09 and off work and I’m in for surgery. I had the nerve block in my leg and the surgery went well. The doctor removed the damaged and dead tissue and stitched it up and I had a cast on my leg up to my knee with my toes pointed down. I was on crutches NWB.

April 2009
I had a follow up two weeks later. Stitches come out, the incision looks good and I’m into the Aircast for the next few weeks. He cleared me to start Physio in a couple of weeks and I started again with my original Physiotherapist in mid April.

May 2009
I had my second follow up with the surgeon and he thought everything looked good. I had some concerns about the swelling and sharp pain I was still having in the lower part of the tendon.  He assured me this is all normal for this type of surgery. I started back to work mid June/09 on modified duties gradually increasing my hours.

June 2009
I’m back at work at a desk job. I’m increasing my hours every week. I’m still having a lot of pain and I’m not making a lot of progress at Physio.

July 2009
I had another follow up appointment mid July/09 and I again expressed a concern about the continued soreness, sharp stabbing pain and little progress as for lack of strength gain in my calf. He assured me that I would continue to have pain and swelling for several more months as this is normal for any ankle surgery.

August 2009
At the end of August I was still having the sharp stabbing pains and the tendon is even tenderer. I’ve been getting the sharp stabbing pains more frequently and with more intensity. I still can’t walk very far and my strength in my calf is not where I think it should be at. I had to back off on the Physio because of the sharp pain. I had to drop all the resistances back to where I first started.

September 2009
After a discussion with my Physiotherapist we decided a call to the surgeon was in order. An appointment was made and after a short examination by the surgeon he ordered an MRI.

October 2009
On Oct. 2/09 I had the MRI and I’m waiting for the results. The pain continues.
Oct. 21/09 I get the MRI results.

I got the MRI results and here we go again. A second surgery is scheduled for Nov.9/09. The Dr. is going to redo the surgery again. There is a lot of inflammation and he is going to do another debridement and possible tendon transfer if needed.