First Physio Visit

Had my first visit to the Physio yesterday.  I’d been in a cast for 3 weeks and then 4 weeks at 30 degrees foot position in theVacoped boot.  The consulltant had described a process of 30/15/0 degrees so I was surprised when the Physio went straight to 0 degrees and has introduced a limited range of motion.  She asked me to walk up and down the corridor.  That was very wierd, to be moving the foot after all that time.  She is very keen for me to put full weight on the foot.  I have to say that there were a few tinges of pain in the heel for the first time but that has pretty much gone now.  With this setting, the mobility is good and I can walk without crutches.  Planning to venture out into the big wide world on Monday.  That will require some serious walking.  I have to say I’m impressed by the Vacoped even though I’ve got nothing to compare to.  I’ve been given instruction on how to make the next adjustment to the boot myself which changes the motion settings.  I also have a program of resistance training for four weeks using giant rubber bands.  Into shoes in 4 weeks is the prediction.

There are squash courts here!

Two days before a business trip to Riyadh, Saudi Arabia, our  advance party extolled the virtue of the hotel and the squash courts.   Having been an avid player in my younger days I thought nows the time to get back into the game.  I’m 52 but reasonably fit, I do a bit of running and walk 12 miles a day.  I wasn’t expecting therefore, one day into the trip, to be just getting into my first squash game in 15 years to feel something seriously give way on the back of my ankle.  I still had some movement in my foot and no real pain so I thought it may be a serious strain.  Lots of ice and a visit from the hotels sports manager, I’m having a recommended massage from the sports masseure.  No real improvement but I know where it hurts!  Hobbled around for a day but my calf is swelling seriously. I decide to call my international medical insurance helpline for advice.  They book me straight in to see an orthopaedic consultant.  He sends me off to have an ultrasound.  Diagnosis is no tear and no DVT.  Consultant then puts me in a back slab cast for a week and sends me off to buy some crutches (hopping!!!!) I go back a week later.  Consultant is concerned about swelling, so I have another ultrasound, this time the diagnosis is an almost complete tear, no DVT.  Consultant then sends me off for an emergency MRI, and wants the results advised over the phone to him, if the tear is over 5mm he will operate the next day.  One radiologist writes up a report but a different radiologist,  the one who made the tear diagnosis, interprets the MRI over the phone to the consultant.  Yes there is a tear and the consultant recommends an op the next day.  He speaks with my insurance people.  I go back to the hotel and get a call there from the insurance people who advise me to wait until I return to the UK to have any operation.  Now I am in a dilemma, do I get the op done in Saudi or wait,  I suspect there might be an element of wanting to get me to wait so the bills are less but I have a week left in Saudi.  I’d heard it was best to get the op done asap to minimise possible later complications.  I decided to take the consultants advice.  So I go to the hospital ready to have an op.  The consultant checks the MRI report but that is inconclusive!  He has a long conversation with the two radiologists who are fundamentally disagreeing.  The doc says he has to go with the opinion of the senior radiologist. No tear so no op.  He puts me in a full leg cast,  Still concerned about the swelling.  The insurance people insist I have the cast split before flying, so back to the hospital.  Get back to the UK and have another ultrasound.  This confirms I have a tear and also a clot below the knee which explains the swelling.  So I’d already been in plaster for about three weeks but the radiologist and UK consultant has moved the ankle so much during examination the consultant says the previous weeks have been undone.  He does not want to operate because of DVT  and because the tear is quite high and in a difficult position so I am being treated conservatively with early partial weight bearing in a  vacoped boot for four weeks, initially, at 30 degrees.  Now 3 weeks in and getting quite handy with the crutches.