Re rupture not confirmed…..I need an MRI scan

Well, I went to see the surgeon today. Not the guy I have been seeing but this guy is equally as good apparently. Not what I was expecting to hear. Firstly, when I told him I had failed the Thompson test in A&E last Friday he looked at me with utter disdain (didn’t like that but I was in his hands so bidable), I spluttered,” Erm the simmonds test” (trying to look like I knew a little). He replied, “There are two parts to that test so lie on your front with your lower leg hanging off the bed”. I did as I was told.

He then said,” I have good news for you, your foot is resting in the normal position which indicates your tendon is still in tact”. I did not believe him……..He then felt along my tendon and said he couldn’t feel a gap…..But then I failed the squeeze test. He still said he felt my tendon was in tact and not a re rupture. I couldn’t quite take this in after being told in A&E ( the ER room) that it was ruptured and they had seen it on the ultra sound. He asked me if I had felt pain. I told him it was very painful for about an hour then nothing but a very sore calf. I asked him if I needed an ultra sound. He said no, it would not be conclusive and that I needed an MRI. I was happy with that but I did NOT expect what was coming next………He said “GO HOME AND PUT YOUR TRAINERS ON AND WALK ON IT”!! I said “Er I don’t think so”…He said, ” I don’t think it’s ruptured, go home and get that calf working”. I had been back in an equinis (not sure how to spell that), cast since Friday. I looked at him, he looked at me…..I KNEW I would be putting my boot on, HE KNEW I would be putting my boot on….so I smiled and said, “OK, I’ll try walking in my trainers but if I’m uncomfortable I’ll put my boot on OK?” He did not say OK….I came home and put my boot on, with TWO heels wedges in (I have since taken one out).

I am bewildered. He said clearly something has happened but he didn’t know what. Could have been the sheath around the healing tendon, could have been scar tissue. I should be happy, I should be over the moon…….. but why did I fail that squeeze test which I was responding to so well? He could NOT answer that question and I guess that’s why he wants me to have an MRI. He was a very ANTI surgery surgeon and said he only operates on these if he really has to and he also said that nearly all his re ruptures are on surgical repairs because people think they are stronger when they are not so they push themselves more and pop they go. I asked him why top athletes like David Beckham go for surgery and before he could answer I said is it because they can afford it…….He thought and said probably or maybe they are just badly informed. I thought that was very interesting. I won’t name this doc of course!

So, here I am. My achilles feels sore. I am FWB back in my boot. No way am I putting my trainer on today, I simply cannot and neither would he if he were in my boot…….I will get an NHS MRI within two weeks which is not too long to wait and is palatable because I can FWB in my boot again. I know if I need surgery it will be back to square one but at least I am able to walk whilst I wait which makes it a little more bearable. So I wait and I wait…

Has anyone else out there had this sort of experience. I have read on this blog about popping sounds and some like Durwoods have been re ruptures and other were not but I can’t remember whose were the were nots so to speak.

I’ll keep you posted when I get the MRI…who knows? I live in hope and my boot again for a while!

32 Responses to “Re rupture not confirmed…..I need an MRI scan”

  1. Fingers crossed Sheena - it’s important to be comfortable boot and I would of done the same as you regarding the situation.

    Eva10 had a close call not too long ago, maybe thats one of the references you were looking for.

    I have everything crossed that this is not a back to square one, what gives me some hope is that you have dropped a wedge out the boot already - if it were me I’d take this as a good sign until proven otherwise.

    I hope the MRI appointment happens real soon, stay positive :)

  2. Hi Andrew,
    it is Eva 10 so I’ll take a look now, thanks!

  3. Hey Sheena! I’ll tell you a little bit more about my scare. My brother eventually told me I hit a gopher hole and what I felt was tearing, but not popping. My achilles area immediately became red. I went straight to the ER as it had become swollen and was quite painful. The doctor did the Thompson test and could only tell me something wasn’t quite right. At that point my foot was not laying even like my uninjured foot was and I was certain it was reruptured.

    When I saw my Ortho (4 days after the gopher hole) he told me to push down. I recall not being able to push down a whole lot and all the strength I had built up was gone. I had my boot with the wedge in for about 5-6 days in total if I remember correctly and then things started to feel better. I had calf cramps over night so I was fortunate that I was in the boot. Within 7-10 days I was walking in 2 shoes (where safe) and in the boot without the wedged heel.

    I have a similar timeline as you and I am still on course for a full recovery. I hope it was only scar tissue coming apart for you as well. I remember being scared to death that I had reruptured but after a week it became clear that it was not the case. You have a whole community of people keeping their fingers, toes, and possibly eyes crossed hoping for a rerupture to be dismissed. :)

    Hang in there in Sheena. If there is anything you want to ask based on my experience then please ask away…

  4. Eva,
    thank you so so so much for coming back to me straight away, so kind. I live in hope and secretly am trying to be positive. Time will tell. I’m glad you’re doing so well but one thing this has taught me is to not over do it. The regret I have felt all weekend was awful. I wouldn’t wish it on anyone.

  5. Your welcome Sheena!

    When it first happened I was back on crutches for a few days too, before I could wean off it, and then I weaned off the wedged heel…

    If it turns out to be scar tissue, then it needed to happen and you will probably have a better range of motion than you did before as that was my experience.

  6. Oh Sheena, what a palaver and how confusing! It must be so frustrating for you! But fingers crossed it will be a good outcome and you will be back on the road to recovery really soon. I think we’ve all been shocked by your incident so good luck with your MRI :-)

  7. I had a very frightening pop in mine right around 12 weeks:

    achillesblog.com/ryanb/2011/11/17/the-monkey-thought-twas-all-in-fun/

  8. Thanks guys, it is a palava!
    Ryan, I will take a look right now.

  9. Ryan,
    did you hear a loud pop and feel it recoil? I’m sure I felt something really give and I was in pain for a good hour or so. My calf is still sore.

  10. Pop: yes. Recoil? Not so much- maybe a little snap. Obviously, it ended up not being a total rupture, which would have resulted in a massive recoil of the calf muscle (as in the original injury). The pain I had after my pop was pretty localized, right down by the injury site. With the initial injury, my worst pain was up the calf- no doubt triggered by that big recoil.

  11. Maybe the recoil was in my head put there by horror and fear. My pain was at the site and yes I have a sore calf hope my tendon isn’t nestling somewhere in my calf!

  12. You’re in a boot, which you can take off. I would simply reach around back there, and feel - with your fingers - the tendon. Can you grab and wiggle it? Can you find, pinch, and manipulate it? Or, do you have diffuse puddle of mush back there? If you can find it (intact) can you feel along it for a divot, perhaps indicating a partial re-rupture?

    Grab your other (good) side, and wiggle it. You can tell what a intact tendon should feel like.

    When I had my “pop” that’s the first thing I did. It was pretty easy to determine that I did not have a complete rupture again- I most definitely had a continuous strand running back there.

    Is the swelling so bad so as to inhibit this basic self exam?

    Davidr suggests testing to see if you can push with your toes. That’s not a 100% test- my initial injury was a total and complete tear, yet I was still - with my injured foot - able to operate the gas and brake pedals on my car- driving myself to the clinic. There are a lot of other little support muscles in your ankle which can be called on to (weakly) articulate the foot.

  13. Ryan,
    the doc did all the above and said he flet it was continuous. He did have me psuh hard against his hand and said i wouldn’t be able to do that?
    The thing that worries me most is I was doing well with the squeeze test but today hardly anything.
    I feel no mush at all but the ER guy said that could be scar tissue. I guess the MRI will tell.

  14. Ryan,
    I have just done all the things you have mentioned. I can feel a gap I think, an obvious gap but I can do all the other things that you mention. I do not have a response from the squeeze test though and I feel in a complete whirl as the doc said no but I feel yes. I’m too scared to walk on it though. I don’t have any swelling though, or no more than I did have anyway which is minimal…Don’t know what to think really but my heart says he may be wrong…So I guess I do feel a bit of mush. I wonder if because I came straight out of the cast there wasn’t a gap there until I put weight on it in the boot?? I’m sure it feels like a gap…..

  15. Sheena, your story is reminding me of a blog by Mark Black, he went through a similar scenario last year. Not identical but same kind of uncertainty for a while. (He didn’t have a rerupture in the end). I dont find it that easy to find,try this link http:/ /meandmyachilles.wordpress.com

  16. Ali,
    I read Mark’s blog and he did have a similar story…I can feel a gap and I don’t pass the squeeze test yet the doc said no…I am very confused. I feel it is re ruptured…….

  17. The immediate swelling in my leg was severe and no chance of feeling the tendon. Also, the pain was quite high and caused the initial doctors to get it wrong and diagnose a probable calf (gastrocnemius) tear. No Thomson test. This was at a hospital near to my work. Just felt like my heel had turned to wood vaguely connected to my leg.

    After a week of wearing a compression bandage I saw my GP and he had me admitted to the specialist centre near to me within 48 hours. I was quickly seen by consultant who immediately diagnosed the ATR, did the test, then backed it up with an ultrasound scan on which even to my untrained eye, I could see the complete rupture. It seems that at the time of my accident, a few threads remained intact, and gradually went off over the next few days like guitar strings while I was walking gingerly around with one crutch…

    Straight into equinus cast, followed 2 weeks later by the vaco boot.

    Good luck with the scan Sheena, keep checking for cancellations so that you can get in earlier.

  18. I just read a post from Mark on 27th, I didn’t see this till just now. The uncertainty indeed is hard. Hoping for the best for you.

  19. I like Hillie’s guitar string analogy. I think my tendon - made up of a bunch of those strings, was probably sewn together with one of them too short/tight. It was taking more than it’s share of the load, and eventually snapped (my pop). That’s how I’ve always pictured it anyways, and it explains a whole bunch of things I experienced, both before and after the pop. Maybe that’s a “micro-re-rupture” ;-) So, after my pop, the remaining 95% of my tendon was there, and I healed normally from that point forward.

    I’m wondering if your case might sort of be the opposite Sheena. Maybe you had a few strands that were longer than the rest. The main bulk let go, but you’ve got a few that survived the incident. So, you have a weak response to the Thompson test, but feel a gap, felt a (big) pop, etc.

    In any event, we’re all just guessing until you get the image results back. Until then, be careful with it, and keep your fingers crossed.

  20. Ryan,
    I think you may be right actually. I wonder if I am holding on with one guitar string?
    would it swell again if it had re ruptured I wonder? there is no swelling.
    Can I ask you a question please Ryan? If this was you and you were not sure, would you put your boot back on or do as the doc said and walk on it? If I wear the boot again for the next two weeks will I get a false reading on that MRI, will it look like the tendon is attached because it has vaguely re attached because i have been wearing my boot and the minute I put pressure on it those fibres just gently fall apart again with no pop because there isn’t enough tensile strength to go pop??? I hate waiting and not knowing.

  21. I’m sure the not knowing is awful! Well, hang in there and know that there are lots of people rooting for you.

  22. These “what would you do” questions are always tricky, and most will usually avoid answering them… but I’ll try to answer it for you.

    If it was me, I would figure out the most aggressive configuration, that did not cause instability, swelling, or pain. In other words, I’d try to figure out what I was currently capable of. Fixed boot with heel wedges? if that’s OK, let’s try reducing the wedges. If that’s OK, maybe a flat boot. If that works out, then maybe shoes with some lifts. Etc. This would be a very slow (over the course of a few days) experiment, taking very small, gradual steps. Look for signs of pain, undue swelling, and pause/back-off if/when things show signs of over-stressing. Figure out just how much of a setback this pop was, and re-start the protocol from the appropriate place.

    However, that’s *me*. And, patience is not one of my best qualities. It would drive me completely bonkers to think that I was *wasting* ~2 weeks of potential recovery time, waiting for the MRI. The safe thing to do is put the boot back on, wedged up into a plantar flexed position, and get the crutches back out. That’s probably not what *I* would have done though.

    The other thing I have to say is that this course of action is based upon how I’m guessing things are feeling for you. You’ve done a good job describing you symptoms and such, but part of my path would simply be guided by “how things feel”, which is somewhat of an intangible. I’d stop if/when things didn’t feel “right”, and that’s just really hard to describe/gauge over a series of blog comments.

  23. Ryanb’s response seems to make so much sense, he must be one of those very logical level headed people! I am so sorry that you have to wait even longer for a definitive answer.

    Will be thinking if you.

  24. Sheena,
    I can see why you are having trouble trying to decide what to do. Your doctor’s visit did appear to result in some paradoxes. You failed the squeeze test but your doctor told you your tendon is still intact, yet he felt it inconclusive enough to order an MRI, then tells you to walk around in 2 shoes. Regardless of whether walking around in 2 shoes will further hurt your tendon or not, the instability of your ankle could put you at risk for collateral damage to other parts of your foot, ankle or leg. I think you are wise to stay in the boot for now. If you want to experiment, I agree with ryanb. Take it slow, one step at a time and monitor how you feel. Now it if it was me, part of me says stay safe while the other part says follow the doctor’s orders and get it over with one way or another. Yet given the questionable conclusion your doctor came up with and the risk of more damage, I’d probably lean to playing it safe. It almost sounds like his major concern about you going into the boot was not being able to work your calf. How much more could your calf possibly atrophy in 2 weeks???

    That was an interesting response to your question of why pro athletes don’t go non-op. While I am a big fan of non-op, I have often wondered why that was the case. Your doctor implying that other doctors are misinforming athletes does seem rather cheeky. Yet it could very well be the case.

  25. Hi Sheena

    Hope that you slept well with this worry on your mind.

    You’ve had more answers in a short space of time than I’ve seen in my few months coming here. Lots of advice too including how best to spend the next 2 weeks. Like Ryan and some of the others I am not the patient type and would be feeling around the wound, deciding how best to be mobile, all that stuff.

    However, you have so far been denied even an ultrasound scan, which in most cases would help provide a definitive diagnosis. I doubt that most of us had MRI scans - excellent though they are, there are too few machines around and waiting lists can be long. Even if you don’t do any more harm in the coming days, having the ultrasound could put you on the road to recovery sooner, enjoying yourself again and able to get out and work.

    Your GP ought to have contacts that he can persuade to see you and do a scan. You have children, and a job, and need this fixing asap. Different hospital maybe, but that’s possibly what you need.

    So, how many calls made so far?

  26. Hi Hillie,
    I called the MRI scanning desk this morning and they have put me onto the cancellation list for what it’s worth. To be honest Hillie I agree with everything you say but I think I will wait for this scan now. I believe it is ruptured I feel I can just feel it in by bones so to speak. The MRI will give an exact picture of what it looks like and after reading Mark Black blog where he had the ultr sound people telling him was a re rupture and failing the squeeze test with another doctor, to then see his own consultant to be told he thought the scan people were wrong and then his guy got him to show a week response to the squeeze. Mark spent a week in agony having been told he re ruptured by the ultr sound dept then to be told different by his doc. He was put back in his boot which is what I have done so I guess now I will wait. I feel OK as I can walk. I know if I need surgery it may not be for 3 weeks or so but the surgen yesterday said that walking in my boot won’t make any difference to the outcome of that potential surgery.
    Once again, EVERYONE, has been so kind and helpful here but personally I do feel it has gone. I have had quite a lot of what feels like nerve pain swirling around my ankle this morning when I had none at all in the equinus cast all weekend.

  27. Sheena, you’re a patient person.

    I guess that at least during the 2 weeks, your leg will be doing some kind of healing, and you do have a boot to help you. Just re-read Mark’s blog - had a number of MRI’s and ultrasounds didn’t he?

    Olympics back on tv. I obviously mis-timed my ATR!

    H

  28. I usually trust the Thompson calf-squeeze at LEAST as much as USound or MRI! Another “test” is trying to walk up stairs in 2 shoes. If your life flashes past your eyes and you then switch to fitting your heel onto the step, you’ve got an ATR. Sheena if you’ve gone to FWB right away in the AirCast, then you’re not following any non-op protocol, so I’d say you’ve opted for surgery (unless you have NOT reruptured).

    The GBR Gold Medalist (I forget which sport) who was diagnosed with an ATR of some kind (or possibly a vertical tear?) last February did not have surgery, and won the Olympics in his sport.

    But 99% of elite athletes do still get the surgery — even on the Toronto pro football team, where my non-op Sports-med OS is Chief Surgeon. I thin part of the answer is inertia, herd mentality, etc. Most athletes won’t be reading the studies, and the contrary evidence is still quite new. But some of it is probably a rational response to the evidence. With or without surgery, around half of pro athletes with ATRs cannot return to their former level of play. (The study I saw was US football players.) and even the UWO Study showed a small strength advantage (not statistically significant, but still apparently “there”), which a pro athlete might well want to pursue, just in case it’s real. Complications are a valid factor for “normal” athletes, but less so for pros and Olympians, who might be willing to bet the farm on top performance.

    I’ve said it before: If I were a pro athlete like Beckham, I’d probably fly to Japan to get the super-duper surgery described in a study I linked in my own Studies blog page…

  29. Hi Norm,
    I put my boot back on because this ortho surgeon said he thought it was still attached? I’m not so convinced. I have walked a few steps and it feels OK. I can feel a little tension at the back but no where near as tight as it was before. It used to fel like a vice in the mornings. There is no swelling and it looks good. I can feel a divot but not mush.
    When you say walk up the stairs do you mean on my toes almost Norm? Even when walking up the stairs before this incident I put my heel on the whole step. I never felt I could do othewise.
    If it is still attached I put it in my boot as it feels safer. Should I have come home and put it in the boot with 4 heel wedges and NWB on it for two weeks? I don’t know. My usual doc is back next week so I will pay to see him……

  30. Hey there Sheena,

    Sorry to hear about your dilemma.
    How do the wedges work? Are they meant to shorten the tendon so it can heal? I had a long period of NWB in casts and that was the principle behind the equinus cast which they put me in first. If it is a rupture wouldn’t the wedges in the boot do the same and if it isn’t then maybe having some support will help it until you get a diagnosis. One other thing - do you have an Aircast (I forget) - perhaps changing the amount of air in the back panel will alleviate some of the pain? I hope it’s good news for you.
    Jaxx

  31. Oh Sheena!
    I can’t believe what I’ve been reading about your possible rerupture! How infuriating! My thoughts are definately with you.

    I have just come back from the hospital (optimistic with my right shoe in my handbag, having removed my last wedge last night!!!) where I was told that they wanted me to put the final wedge back in for two more weeks and then two weeks no wedges (they wont consider two shoes til I’ve done 13 weeks - unlucky!). I didnt dare tell them I had been walking baby (non-foot-flexing) steps barefoot n FWB at home! I had been thinking about you - two shoes and driving and was hoping to be boot free!

    I hope all’s going well with the check up n so sorry to have read the news.

    Kind regards,
    Molly

  32. Sheena, I think that’s about what I meant about climbing stairs. “Normal people” let their heel hang out over the air when climbing stairs, with all their weight on the ball of the foot (& on the AT and calf muscle). People with injured ATs REALLY don’t want to do that. But if you hadn’t “graduated” to that move before your setback, then there’s no diagnostic test there, sorry.

    Molly, esp if you’re non-op, the evidence is pretty clear that long slow rehab (like 13 weeks immobilized instead of ~8!) leads to worse clinical outcomes than fast rehab like bit.ly/UWOProtocol . For post-op, going slower doesn’t help, but it doesn’t seem to hurt as much as it does post-non-op — and it’s still a bloody nuisance, of course! You would probably benefit from becoming the Patient from Hell — er, umh, your own Patient Advocate! ;-)

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