10 week update - fatty tissue in retracted tendon gap?
I saw my doctor today - he had asked me to have an ultrasound done on my bad ankle, we looked at the report today and he seemed concerned with the result. Next thing is that he wants me MRI’d, which is probably going to happen next week. I can’t make much sense of this ultrasound report today. The report says, amongst other things, that a) i might not have had a full rupture and b) there could be fatty tissue filling the gap, which really concerns me. How likely is that?
This is what the ultrasound report says (9 weeks after start of treatment):
“The achilles tendon has a normal appearance as it attaches to the calcaneus. Just proximal to this, there is some moderate tendinopathy. Approximately 5.0 cm proximal to the attachment of the achilles tendon to the calcaneus, there appears to be a tear with retraction of fibers extending over a variable length, on average about 1.7 cm. there is some echogenic or likely fatty tissue extending into the retracted tendon gap. The tear definitely extends through the ventral aspect of the tendon. I think there is a small slip of intact tendon fibres along the dorsal or posterior aspect of the achilles tendon, about at most a couple millimeters thick. There is no evidence of hypermia across the area of tearing.
The tear is very deep and extends across the full width of the tendon. I think there is a thin slip of intact tendon fibers across the dorsal aspect of the tendon. There is some echogenic material filling in the retracted tendon gap suggesting hemiated fatty tissue and/ or fibrotic tissue.”
So i am not sure what to think about this report, also because the doctor did not want to say much. He is also concerned about the “fatty tissue” remark and wants to exclude this possibility by having an MRI done. If there really was fatty tissue, it could inhibit the tendon healing, which concerns me, of course. I hope it’s just collagen. According to doctors in the family Differentiating the inflammatory tissue of normal healing and a fat intrusion should be very difficult on ultrasound. Fatty infiltration is usually associated with muscle atrophy.
Other than that i am progressing according to schedule, I guess. I am out of the boot and walking in 2 shoes during the day, but i wear the boot at night. I transitioned from the vacocast into two shoes and I can recommend using a hinging boot. The adjustment in the vacocast can also be done very incrementally (5 degrees at a time), which I found helpful. I brought it down from 30 degrees (week 6) to hinging +10/-10 (week eight) gradually, took two, sometimes three days for each step. I still walk with a limp (of course). Actually Two days ago was my first day completely out of the boot. As exercises i do two legged heel raises with support (i hold on to something to keep my balance), but there is not much push off coming from my bad leg. I ride on my spin bike about 1 hour in total per day, with some resistance to train my bad foot and gradually work on strengthening. As with most other people here progress is very slow and not much is happening day after day, but at least i’m walking in 2 shoes. My foot swells up a lot during the day, but that’s usually all gone the next morning. When walking i try to walk slowly and really focus on getting at least a tiny bit of push off in the bad foot.
As for shoes i got myself some NB Minimus shoes because my PT said it would be best if i walked barefoot most of the time. I can’t do that in the office, so i bought some shoes that claim to be close. I bought the minimus ones that have a bit of a heel lift (4 mm).
I liked sporti’s approach tracking his steps with a fitbit. I got myself a fitbit, too, and defined my threshold at 9000 steps per day for now (a healthy person should do about 10,000 a day). I try to get to the threshold every day (manage only sometimes to do so…) and focus on pushing off with my bad foot. Along with the cycling and the other exercises this is my program for now. I feel good about it and i get the feeling, now that i have done this for a little over a week, that there is incremental progress.
As always, i am very interested and looking forward to your comments.