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.
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Oh, rainbow, what a horrendous story. Sounds like a ping-pong ball (or a squash ball for that matter) has nothing on you. Since we know that conservative treatment can lead to excellent results, I agree with your consultants that the DVT rules out surgery. If said DVT breaks loose during surgery, then the results of the surgery won’t matter a bit. Good luck, Ron
Thanks ultidad. I gather the hospital have been using the Vacoped for just over a year and their re-rupture rates are zero to date. Not sure if that is long enough to tell much as I’m on the learning curve that I guess all of us have to go through. I’ve done some reading and one study specifically focussed on comparing conservative treatment with surgery but trying to see if there was any difference in re-rupture rates if weight bearing was introduced early in the conservative treatment. It concluded the weight bearing did have a positve effect.
A note on the Vacoped. It has certainly improved my mobility. Still using two crutches. It does allow you to take it off to let you wash the leg. There is a liner made of cloth nappy type material which is washable. My hospital did not give me a spare liner until I chased them. The Vacoped website documentation does say two liners should be given to allow you to alternate.
Quite a story…
There were a couple of people on this site who used the VACOped boot and they were most satisfied with it. eg see http://achillesblog.com/mstahlka/
The early weight bearing sounds promising, too.
Hope your recovery will be straightforward from here on. Good luck!