pete0609’s AchillesBlog






         Just another AchillesBlog

June 4, 2014

11 week update - Fatty inclusion

Filed under: Uncategorized — pete0609 @ 9:17 pm

So i am in week 11 now and in my last post i mentioned that ultrasound imaging has discovered something that could be fatty tissue in my tendon. My doctor was concerned about it (a fat pad could inhibit tendon healing in that section) and sent me to have MRI and x-rays done. Diagnosis was confirmed and there seems to be a fat inclusion in my tendon (0.4cm x 1.6cm). It remains unclear where that fatty tissue came from, but in the course of tendon degeneration it is not totally uncommon that something like this would develop, my doctor says. It probably was already there before i ruptured my AT. He discussed the problem with a sports surgeon, who recommended to just keep doing what we’re doing and see if the tendon heals fine anyway (they seem to think there’s a pretty good chance). After 6-8 weeks we could consider surgery depending on how well i healed. Depending on the healing progress until then, the surgeon would either just remove the fat pad, or repair the tendon, which would probably put me back to day 1.

The MRI also confirmed i only had a partial rupture (40-50% of the initial tendon still intact), and old partial tears of the PTFL and ATFL, two smaller tendons in the foot. I don’t know what to think about that. I’m not sure i wanted to know how messed up my foot really was.

I kinda wish no imaging would have been done (i’m right there with you, Norm). Everything will be fine and I probably never would have known the difference.

Anyways, i try to keep calm and carry on. I got myself the most expensive socks i’ve ever bought - compression socks (1 pair of Bauerfeind - i paid $125). They do an amazing job, worth every cent. My leg swells up a lot during the day, and the compression socks help to keep this within certain limits, they do it amazingly well. I wear them during the day, not at night. When i take the sock off in the evening, my leg looks almost the same as it did in the morning when i put it on.

Swelling in general hasn’t been a problem for me at all while i was still in the boot. But it really started once i was out of the boot. I got myself some big ice packs that i can wrap around my leg (my PT says to not apply for longer than 20 minutes at a time, but it feels so good).

My fitbit (sporti, i got myself the flex) helps me counting my steps per day. After gaining some experience i lowered my daily target to 8000. The initial 10,000 were too much, together with the heel raise exercises and 45 minutes on the spin bike with some resistance (pedaling basically only with the bad foot), i was more sore and for longer than i wanted to be. I guess i’ll increase the target again after some time, can’t say when, though.

My heel raise exercise - i stand on my bad foot, the other one in the air and both hands on the counter. I push myself up with my hands (while trying to help with my foot) and then lower myself back down slowly, while trying to put at least some of the bodyweight on the bad foot. I do 15 reps, 3-4 times per day.

I still have physio twice per week. It helps to keep pushing myself, but also refraining from things i shouldn’t do.

One other thing i wanted to mention was kinesio tape. When i saw my doctor today he asked me to walk for him and said i walk funny (I ┬ádid and still do, that hip drop…). Obviously my fibula bone (in the good leg!) started pushing out to the side, i felt the bump in the skin, probably from walking in the boot for so long. So he put some kinesio tape over that bone to push it back in and instantly my walking was better, more straight. Thought that was pretty cool.

So in general my rehab is going okay, my leg/calf/tendon still feels fairly tight most of the time, i get next to no push off in my bad foot (maybe a little micro push off), but it’s all still within what could and should be expected according to uwoprotocol, which i am following.

And well, I am in 2 shoes completely now. No more boot.

I am looking forward to reading your comments.

6 Comments »

  1. Pete0609, bummer about the diagnosis but you’ve got the right idea in not worrying about the fatty (did they call it an inclusion or infiltration?) for now — after all these are the same docs who told you that you had a full rupture / 7cm gap a few months ago, so I’m not sure image reading is their forte :) FWIW I could barely find anything on fatty inclusions / infiltrations when it comes to the achilles after doing a quick search of pubmedseems to be a bigger issue with torn rotator cuffs), so if it is in fact what you’ve got down there, I don’t think it’s a terribly big deal. It’s unlikely that you’re the first person to have one, and if it caused problems, there’d probably be more chatter about them in the literature. Of course it’s a good idea to keep monitoring it (and maybe get a second opinion down the line if necessary) but for now it sounds like things are going great, so keep it up!

    Comment by dcoughlan — June 4, 2014 @ 11:17 pm

  2. I also think you’re taking the right approach. There are no guarantees (ever!), but I’m guessing (and hoping) that it’ll end up working OK.

    Comment by normofthenorth — June 5, 2014 @ 3:49 am

  3. Thanks dcoughlan and Norm -
    The terms used for the fatty tissue in our conversations were all over the place - infiltration, inclusion, protrusion, fat pad, my thoughts were also it could be a fat tumor (benign and small they are fairly common as well, in lots of places). And i have to give my doctors some credit - it was the ER doctor who diagnosed a 7cm gap and full rupture, which he put in his report that everybody relied upon. I had the same problem finding something on fat infiltration on the internet, there’s just not much there regarding the achilles. So we’ll keep using the most common approach of modern medicine, some therapy first, give it some time, and then after a while come up with a diagnosis. Injuries suck.

    Comment by pete0609 — June 5, 2014 @ 7:15 pm

  4. Yeah, that MRI is much more accurate. I actually had 4 different doctors diagnose me, 2 said I had a full rupture and 2 said partial. One approximated the ends with my foot starting at 40 degrees PF and one approximated it at 30 degrees. The MRI showed about a 95 percent tear, there was just one tiny little string of spaghetti holding it together so I went with the 40 degrees. But after knowing that, I went through the first few weeks thinking that last little piece might pop at any time. At least you know there’s still close to a 50 percent connection. I bet it will work out great for you and this will turn out to be nothing to worry about.

    Comment by Roark — June 6, 2014 @ 10:06 am

  5. Pete, I’m sorry to hear about your report. I am in week 11 as well so I have been following along on your posts. It is scary to think that conservative method might not heal right. I have been doing PT for the last two weeks and my doctor has not specified whether I will ever get an ultrasound or MRI to confirm it is healing correctly. Were you having problems or could you tell anything felt wrong? I am getting around pretty good in 2 shoes and no longer use my boot. Hoping for the best for your recovery. Brad

    Comment by Brad — June 9, 2014 @ 5:58 pm

  6. Hi Brad, there are no guarantees that you will heal 100% with any therapy. ATR is a big injury and every injury is individual and therefore different. There’s always a chance that a therapy that works in 95% of all cases might not work for you, simply because you’re not the 95% person. So the issue i might have (and nobody really knows if it actually is an issue) cannot necessarily be attributed to the kind of therapy applied. There probably are a gazillion other things that could have gone wrong had i opted for surgery (i still don’t really feel like i had that option at the time). Opting for surgery as the “safer” therapy would assume that all surgeons get the same results - hardly likely.
    Right now i’d like to think that the fat infiltration is not going to make a difference and i’m going to heal just fine. The ultrasound was just done because my doctor wanted to have some imaging from a lab he trusted, because the ER ultrasound was maybe a little sketchy. The MRI was decided after the ultrasound report said there might be fat. I had no issues unitl then, and so far i am fine. I am progressing, my walking is getting better, albeit slowly, incrementally and if i read other posts i don’t have the feeling that i am either ahead or far behind most people at this stage.
    I have been in 2 shoes for more than 2 weeks already, but again, time will tell and we’ll have another look at the fat pad in a few weeks. Maybe it has to be removed. There’s no way to tell right now. My PT told me the story of a former patient who had torn a tendon in his arm that wouldn’t heal, and he went to a specialist who used fat tissue from his hip to inject in the tendon to help build scaffolding for healing. I don’t know if that actually worked, but that fat pad in my tendon might even turn out to be beneficial, after all. No idea. We’ll see.

    Comment by pete0609 — June 9, 2014 @ 9:53 pm

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